Should we call the neurologist? The value and cost of a growing neurology consultation service.

Abstract

St Vincent's University Hospital has an established neurology consultation service. Referral volumes have been growing. The Department regularly reviews its service to monitor changes and seek improvements. We sought to determine the impact of the growing service on patient care, on the department itself in delivering the service, and on inpatient admission trends. We reviewed the electronic referral forms of all consults seen over a 9-week period in 2014 (n=213). We recorded the source of each consult, demographic information, clinical presentation, time from referral to consult, and outcome. We compared the consult list to inpatient admissions list to determine the proportion admitted from consults. We compared our results to previous reviews by this and other neurology departments in Ireland. Three quarters of neurology consults relate to acute admissions. Patients are all seen within one working day of referral. A significant change in management (83.6%) resulted from the majority of consults. Consultants see an average of 4.8 (range 0-10) consults per day, needing up to 7.5h per day to deliver the service. One-third of the department's inpatients come from consults. The service significantly benefits patient care. The increasing number of consults will require increased resources and/or service reorganisation to maintain the current level of service.