This was a retrospective audit of 30 patients over an 8 month period from September 2014 to July 2015 with Motor Neurone Disease on referral request or in the Neurophysiology opinion.
The purpose of the Audit was to review practice at the Clinical Neurophysiology Department in Glasgow and result patterns of EMG/NCS for patients with suspected MND. In addition, the aim was to check compliance with MND Quality Standards for Scotland regarding access to Neurophysiology. This included a review waiting times for electrodiagnostic tests from when the referral was received to when the study was performed. We also looked at whether the Awaji-Shima Consensus and Revised El Escorial Criteria recommendations were being followed. We were also interested in how helpful Neurophysiology was, i.e. how many studies were confirmatory.
The results of the audit showed that MND Quality Standards Scotland Essential criteria 12.1 of access to Neurophysiology within 20 days target was not met in half of the referrals. The mean waiting time for Neurophysiology was 5 weeks but 48% of patients waited longer than the 4 week target.
Awaji-Shima Consensus and Revised El Escorial Criteria recommendations for electrodiagnostic evidence of lower motor neurone signs in three body regions to confirm MND was met in 100% of patients with confirmatory Neurophysiology. 50% of confirmatory opinions used the term "supportive of". 20% of patients with confirmatory Neurophysiology for Motor Neurone Disease had dual pathology: length dependent sensorimotor axonal peripheral neuropathy or bilateral Carpal Tunnel Syndrome. MND was confirmed in 30% of cases neurophysiologically and clinically. MND was confirmed clinically in 73% of cases. 27% of cases were not given a diagnosis of MND.
As a result of the audit we have improved the MND pathway for Neurophysiology testing, booking MND referrals into the 6 urgent out-patient slots available each week, done by the on-call Consultant.
The first recommendation was to investigate why the waiting times target was not met in half of the cases, whether urgent slots were being allocated inappropriately or whether there was a lack of resources to meet demand. The second recommendation was to check how our practice compares to other departments in order to develop clinical guidelines.