Metastatic spinal cord compression (MSCC) is a common complication in cancer patients, occurring in 3–5% of diagnosed cases annually, and serves as the initial manifestation of malignancy in 20% of patients. Timely diagnosis and management are critical due to the risk of irreversible neurological damage and the significant impact on both quality and quantity of life. The National Institute for Health and Care Excellence (NICE) recommends that patients presenting with back pain accompanied by neurological signs and/or symptoms undergo whole-spine magnetic resonance imaging (MRI) within 24 h. This retrospective study at Medway Maritime Hospital in England aimed to assess adherence to these guidelines by reviewing the time from presentation to MRI for patients exhibiting symptoms and/or signs of MSCC. Data for 69 patients were collected over one year using electronic patient records and the acute oncology service database. Analysis revealed that MRI was conducted within 24 h in only 43 out of 69 cases (62%), and 16 out of 25 delayed cases (i.e., MRI done beyond the recommended 24 h window) experienced delays of more than 48 h. To improve guideline adherence, interventions such as informational flyers and regular MSCC training sessions, including trainee teaching and presentations during grand rounds, were implemented. A follow-up re-audit involving 113 patients over one year demonstrated improved adherence to the 24 h MRI guideline, with 81 out of 113 cases (71%) meeting the target. The second cycle also documented reasons for delays, identifying patient compliance and pain control as primary factors. Additionally, the timing of steroid administration following suspicion of MSCC was recorded. Future studies should re-assess adherence, focus on better documentation of delay causes, enhance pain management before MRI scans, and ensure prompt steroid administration.