Rapid Access Neurology Research Articles

Improved care and management of paediatric neurological patients evaluated at a paediatric Rapid Access Neurology clinic: A pilot study.

Referral wait times for paediatric neurological patients are increasing, leading to an increased burden on the emergency department (ED). The paediatric Rapid Access Neurology (pRAN) clinic was created for paediatric patients who are clinically stable, but require an urgent paediatric neurology consultation. The objectives were to evaluate the pathways of referral, accuracy of referring diagnoses, adherence to clinic appointments, impact of clinic visitation on ED visits and patient satisfaction. Data were collected from the pRAN clinic from March 2018 until April 2019. Information was obtained from patient charts including the referring and final diagnosis, management plan and the number of visits made to the ED before and after visiting the pRAN clinic. Of the 256 referred patients, 91 met inclusion criteria. The most frequent referral diagnosis was a seizure. Referring physicians and pRAN clinic neurologists differed significantly in the level of diagnostic agreement for patients <2 years of age (P= 0.03; 95% confidence interval (CI) -0.294, 0.373). There was a significant reduction in visits to the ED made by patients 3months after the pRAN appointment compared with before the visit (P< 0.001; 95% CI -0.9070, -0.4088). The majority of patients felt that the clinic had high value and were satisfied with their follow-up plan. This pilot study showed that a pRAN clinic can improve the accuracy of neurological diagnoses and management, especially for children <2 years of age. In addition, pRAN clinic patients make fewer subsequent visits to the ED and express high satisfaction with their care.

Rapid access neurology: a 2-year evaluation of ‘hot clinics’ in a tertiary neuroscience centre

Patients with neurological symptoms account for 10–20% of acute medical admissions.1 Early neurologist contact for this cohort improves diagnostic outcomes, reduces length of stay and avoids diagnostic procedures.2 The rapid access neurology clinics (‘hot’ clinics) at St George's Hospital (SGH), London, are part of an innovative hyperacute neurology service that aims to reduce the burden of unnecessary admissions to the acute medical take.2 Future-proofing of such services require a proactive approach to how they are being utilised. We analysed this in greater detail. We analysed referrals to the hot clinics from August 2016 to July 2018, assessing the performance of the second year compared with the …

P.073 Improving access to urgent neurology care for pediatric patients

Background: Pediatric neurology referral wait times are increasing, often leading to emergency department (ED) utilization. On average 5% of ED patients present with neurological symptoms and 35% of ED neurological diagnoses are revised after specialist review. A Stollery Rapid Access Neurology (RAN) clinic was created to decrease wait time, and initiate an efficient referral process. Methods: The RAN clinic ran weekly from March 2018 until February 2019. This was a prospective study approved by the University of Alberta ethics board. Inclusion criteria were met. Information was collected for diagnosis, along with confidential patient satisfaction surveys. Results: Seventy-five patients were referred, 49% from the ED. Wait time averaged 6 weeks. The most frequent referral reason was seizures, with 60% of referring diagnosis being correct. Prior to RAN appointment, 61% of patients presented to the ED, whereas only 0.1% returned in the following 3 months. Neurology follow up was required in 81% of patients. Overall satisfaction was ranked 9.6/10. Conclusions: The RAN clinic created an effective urgent triage method. Neurologist review revised 40% of diagnoses. This ongoing study reveals that a RAN clinic can reduce visits to the ED following appointment and initiate appropriate follow up. Future evaluation in cost effectiveness and telehealth appointments are required.

285 Piloting and implementing an acute neurology service

Over the past decade, the number of patients attending the emergency department (ED) at the Royal Victoria Hospital Belfast, with neurological symptoms, has doubled. Typically, over 50% of these patients would subsequently be admitted to hospital. In 2013, a pilot project was conducted with the aim of evaluating the effectiveness of a rapid access neurology clinic on reducing such admissions.A dedicated neurology clinic was set up offering 12 slots per week. Patients were seen within 10 days of ED staff booking them into the clinics. Early results indicated that within the first month 28 admissions were avoided. As a result rapid access neurology clinics were rolled out. Two acute neurologists were appointed and since 2015, 3 rapid access clinics run per week (15 slots). In addition to the rapid access clinics, the acute neurology team also offer two additional services:Reviewing all patients who have been admitted under the medical take with neurological symptomsPatients who attend ED overnight but require urgent evaluation/tests can be sent home and will be seen the next morning by the acute neurology teamAnalysis indicates approximately 1250 admissions are avoided each year with an estimated cost saving of over £2 million.

Experience from two decades of the Cambridge Rapid Access Neurology Clinic

We report on the evolution of the rapid access neurology clinic (established in 1995) at Addenbrooke's Hospital, Cambridge. Annualised attendance data demonstrate an ever increasing demand, with primary headache disorders now accounting for more than 40% of referrals. Secondary causes of headache (including intracranial tumours, idiopathic intracranial hypertension, carotid or vertebral artery dissection and subdural haematomas) remain infrequent. In all such cases, there were additional diagnostic clues. The number of patients referred with problems related to chronic neurological diseases has fallen considerably, reflecting the roles of specialist nurses and clinics. Imaging investigation of choice shifted from computerised tomography scan (45 to 16%) towards magnetic resonance imaging (17 to 47%). Management is increasingly on an outpatient basis, often without the need for a follow-up appointment. The experience presented here should inform further development of rapid access neurology clinics across the UK and suggests the need for acute headache services, in line with those for transient ischaemic attack and first seizure.

Helping patients and the emergency department: enhanced patient care and reduced hospital admission rates with a pilot rapid access neurology clinic (RANC)

To assess the efficacy and acceptability of a rapid access neurology clinic (RANC) in improving access to neurological diagnosis and reducing hospital admissions and investigations for patients with neurological complaints presenting to the emergency department (ED). A pilot RANC was commenced for

CAN A RAPID ACCESS NEUROLOGY CLINIC REDUCE A&amp;E ADMISSIONS?

<h3>Background</h3> The number of patients attending A&amp;E with neurological symptoms in Northern Irelands largest hospital has more than doubled in the past nine years. Over half of those that present to A&amp;E will be admitted; more patients are admitted with neurological symptoms than gastroenterology or cardiology. <h3>Objectives</h3> To pilot a rapid access neurology clinic (RANC) and examine its effect on hospital admissions. <h3>Methods</h3> The pilot ran for four weeks from October to November 2013. Three clinics were held per week with 4 slots available per clinic; slots were filled directly by senior A&amp;E staff. <h3>Results</h3> A total of 45 patients were seen in the RANC and 28 admissions were avoided. The average waiting time to be seen was 8 days. The two main presentations referred to the RANC were headaches and seizure. The average hospital stay for a patient with a neurological presentation admitted to the medical ward is 5.5days at a cost of £541 per day; by avoiding 154 hospital nights cost savings were calculated at £83,314. <h3>Conclusion</h3> Regular access to a RANC could lead to a reduction of unnecessary hospital admissions and substantial cost savings.

CAN A RAPID ACCESS NEUROLOGY CLINIC REDUCE A&amp;E ADMISSIONS?

BackgroundIn the past nine years, the number of patients attending the A&amp;E department of the Royal Victoria Hospital Belfast, with neurological complaints has more than doubled.The number of A&amp;E attendees with neurological complaints is similar to cardiology and higher than gastroenterological complaints. Approximately half of attendees were referred for further investigations or specialist opinion via their primary care physician. Of all attendees only a small number (29%) were referred to or discussed with the neurology department.More than half of A&amp;E attendees presenting with neurological complaints are admitted, mostly under medical team (95%). The number of patients admitted with neurological complaints is higher than for gastroenterology or cardiology.ObjectivesTo pilot a rapid access neurology clinic (RANC) and determine if it is possible to reduce unnecessary hospital admissions of patients with neurological complaints.MethodsThe pilot ran for four weeks in October 2013. Three clinics were held per week with four slots available per clinic; slots were filled directly from senior A&amp;E staff. Only patients that otherwise would have been admitted were allowed to be referred to the RANC.ResultsA total of 45 patients were seen in the RANC. The average waiting time to be seen was 8 days. The two main presentations referred to the RANC were headaches and seizures. The number of CT or MRI scans arranged in the RANC was significantly lower then the number arranged for patients that were admitted. (0.38 scans/patient vs. 1.15 scans/patient). Two-thirds of patients seen in the RANC did not require a follow up under neurology.Questionnaires were sent out to patients that attended the RANC and A&amp;E staff. The response showed an extremely high satisfactory rate in both groups.The estimated cost savings by avoiding admissions were calculated as £46,200 during the 4 weeks. This did not include he costs savings due to reduction of MRI/CT scans.Aside from cost saving, the overall quality of care for patients with neurological complaints is enhanced through rapid access to specialist services.ConclusionThe results of the pilot study suggest that provision of a RANC can reduce unnecessary hospital admissions for patients with neurological complaints. The pilot study received very positive feedback from A&amp;E colleagues and patients. Regular provision of the service may lead to considerable cost savings.Compare time period with and without RANC01/08/13–31/08/13RANC not in place25/09/13–23/10/13RANC in placeA+E attendees71496849Neurology patients479436Admitted269211% admitted56.2%48.4%Referred to RANC048Admission avoided028If no RANC availableAdmission rate56.2%54.8%A and E attendances in last 9 years in RVH by medical specialityYearCardGastroNeuroResp200527211747237124652006235917692292248020072831182225202908200825982247254031502009295920102836328820103103220930503362201133142629363635842012488234014419550420134966383950635714RVH A&amp;E attendances by speciality since 2005Neurological symptoms seen in the RANC

A new model for neurology care in the emergency department

To assess the feasibility of using a rapid access neurology clinic to assess and manage patients considered safe to discharge home from the emergency department (ED), yet requiring specialist neurology review. The ED Rapid Access Neurology (ED RAN) clinic was trialled at Royal Prince Alfred Hospital, a major tertiary teaching hospital in Sydney, over a 12-month period (23 March 2008 - 22 March 2009). The service uses a new clinic and referral system to offer suitable patients specialist neurology outpatient review within 5 working days of their discharge from the ED. Quality of patient care, patient satisfaction, estimated service impact on the hospital system. During the 12-month trial period, 311 patients were referred to the ED RAN clinic. Of these referrals, 222 patients (71%) attended the clinic, where a number of serious neurological diagnoses were made, and eight patients required admission after specialist review. All patients attending the clinic found the visit helpful. Consultant ED physicians believed that the clinic prevented 83 unnecessary admissions and 188 out-of-hours neurology registrar consultations, and saved an estimated 809 hours of ED bed time. The ED RAN clinic provides a viable model for improving the quality of patient care, with high levels of patient satisfaction. This model of care may allow significant cost savings and help to relieve the major access block in Australian EDs.

Acute neurological problems: frequency, consultation patterns and the uses of a rapid access neurology clinic.

In secondary care, some patients with acute neurological symptoms are never seen by a neurologist. Rapid access neurology clinics could provide patients with timely access to neurology services. We analysed a retrospective cohort of 12,024 consecutive patients attending the 'immediate care' area of the emergency department or the acute medical admissions unit of the Royal Infirmary of Edinburgh. A total of 1,036 patients (9%) presented with a neurological complaint, of whom 680 (66%) did not have any contact with neurology services. The most common problems were epileptic seizure, cerebrovascular diseases and headache. Of the patients with epileptic seizure or headache who were not seen by a neurologist, about 40% might have benefited from neurological assessment. Following the introduction of a weekly rapid access neurology clinic, the most common problems seen were headache, symptoms that turned out to be medically unexplained and epileptic seizure.