An epidural haematoma is a rare, but catastrophic complication of a neuraxial procedure.[1] If not detected early and managed rapidly, it can lead to permanent nerve damage. National guidance recommends that patients who undergo an obstetric neuraxial procedure should be informed of their 4-hour straight leg raise (SLR) time, to allow early detection of delayed neurological recovery.[1]

The James Cook University Hospital (JCUH), had no formal escalation pathway in place for patients with delayed neurological recovery and the 4-hour SLR time was not widely known by the multidisciplinary team. The ‘Regional Anaesthesia Alert Bracelet’ (RA:AB) initiative was developed at Southern Health and Social Care Trust and recommended wristbands documenting a 4-hour SLR time, to aid earlier identification of delayed neurological recovery.[2]

Guidance on how to escalate and investigate these patients was formalised in a pathway at JCUH. We assessed the effect of implementing RA:AB at JCUH.