title: Multiple sclerosis, from referral to confirmed diagnosis: an audit of clinical practice.
abstract: BACKGROUND
  The National Institute for Health and Clinical Excellence (NICE) guidelines recommend a timeline of 6 weeks from referral to neurology consultation and then 6 weeks to a diagnosis of multiple sclerosis (MS).
  
  
  OBJECTIVE
  We audited the clinical management of all new outpatient referrals diagnosed with MS between January 2007 and May 2010.
  
  
  METHODS
  We analysed the timelines from referral to first clinic visit, to MRI studies and lumbar puncture (LP) (if performed) and the overall interval from first visit to the time the diagnosis was given to the patient.
  
  
  RESULTS
  Of the 119 diagnoses of MS/Clinically Isolated Syndrome (CIS), 93 (78%) were seen within 6 weeks of referral. MRI was performed before first visit in 61% and within 6 weeks in a further 27%. A lumbar puncture (LP) was performed in 83% of all patients and was done within 6 weeks in 78%. In total, 63 (53%) patients received their final diagnosis within 6 weeks of their first clinic visit, with 57 (48%) patients having their diagnosis delayed. The main rate-limiting steps were the availability of imaging and LP, and administrative issues.
  
  
  CONCLUSIONS
  We conclude that, even with careful scheduling, it is difficult for a specialist service to obtain MRI scans and LP results so as to fulfil NICE guidelines within the optimal six-week period. An improved service would require MRI scans to be arranged before the first clinic visit in all patients with suspected MS.
authors.affiliation: Department of Neurology, St Vincent's University Hospital, Dublin, Ireland. sb.kelly@st-vincents.ie
authors.forename: S B
authors.initials: SB
authors.lastname: Kelly
authors.forename: E
authors.initials: E
authors.lastname: Chaila
authors.forename: K
authors.initials: K
authors.lastname: Kinsella
authors.forename: M
authors.initials: M
authors.lastname: Duggan
authors.forename: C
authors.initials: C
authors.lastname: McGuigan
authors.forename: N
authors.initials: N
authors.lastname: Tubridy
authors.forename: M
authors.initials: M
authors.lastname: Hutchinson
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000592:standards*; D055815:Young Adult