175 Quality improvement: re-structuring the neurology ‘In-hours’ on-call service at North Bristol Trust

Abstract

IntroductionThe joint ABN and RCP 2011 report advocated for changes in planning of local services to improve access to specialist reviews.1At North Bristol Trust (NBT), we restructured our ‘in-hours’ on-call service to enable early neurology review; as Ali et al.2showed, this alters diagnosis and management in up to 79% of cases referred. These changes include an increase in HOT clinic appointments (rapid access service) and pro-active review of Acute Medical Unit (AMU) patients.MethodFrom 8th August 2019, two registrars have been placed on-call during ‘in-hours’. One is dedicated to referrals and the other runs the HOT clinics and picks up referrals in AMU. Data was collected from an on-call database and processed on Excel.Results>60% reduction in time to review from referralNBT average of time to review at HOT clinic was 3.44 daysNo. of appointments doubled in September compared to June 64% (n=37) of cases were discharged on the day of reviewConclusionsService improvement shown by significant reduction in delay from referral to review in HOT clinicsProactively picking up referrals increase discharges!Reducing length of stay and investigations reduce costs incurredReferenceRCP London and the ABN. Local adult neurology services for the next decade. London: RCP, 2011.Ali E et al. The ‘hidden work’ of a hospital neurologist: 1000 consults later.European Journal of neurology2010 Apr;17(4):e28–32.melissatan095@gmail.com