Hyperacute neurology at a regional neurosciences centre: a 1-year experience of an innovative service model

Abstract

(HANS) is a comprehensive, consultant-delivered service set in a teaching hospital regional neuroscience centre. The service addresses defi ciencies in acute neurological care previously highlighted by the Royal College of Physicians and the Association of British Neurologists. HANS adopts a disease-agnostic approach to acute neurology, prioritising the emergency department (ED) management of both stroke and stroke mimics alike alongside proactive daily support to the acute medical unit and acute medical take. Rapid access clinics provide a means to assess ambulatory patients, providing an outlet to reduce the burden of referral from primary care to acute medicine. This paper reports the results from the fi rst year of the service. Admission was avoided in 25% of the cases reviewed in the ED. Compared to historic data, there was a signifi cant improvement in the length of stay for non-stroke disorders while the occupancy of stroke beds by non-stroke cases reduced by 50%. The confi guration of this service is replicable in other neuroscience centres and provides a framework to reduce the barriers facing patients who present with acute neurological symptoms.

Prevalence of acute neurology: a 2-week snapshot in a district general hospital

“…This will of course have financial implications for trusts, as currently outpatient work demands a tariff whereas inpatient work (ward review) does not (although work by Boodhoo et al and Moodley et al show that there is a potential impact on length of stay and admission avoidance which would be of, not only clinical but also, financial benefit). 9,13 Our experience from seeing significant numbers of ward referrals is that it is only obvious in hindsight which referrals were unnecessary. Experience shows that a serious sounding monoplegia can have a painful joint and the most innocuous headache could be cryptococcal meningitis.…”

Getting involved with Clinical Medicine

“…A more obviously beneficial service development is described by the neurologists at St George's who describe their experience of establishing a hyperacute neurology service. 10 The potential crossover to adapt some of the principles described to other specialty practice makes this an article that all physicians will want to read.…”

Improving liaison neurology services

“…Liaison neurology has no strict definition, but the term has been used to describe the consultation service where neurologists are asked to see inpatients under general medicine and other specialties as inpatient referrals. While a few services offer dedicated neurology beds for all patients with neurological disease and stroke, 8 most patients in the UK and across the world 9–20 who are admitted with neurological disorders are cared for by general physicians. Thus, the main way for inpatients to access specialist neurological opinion is by referral through a liaison neurology service.…”

“…A neurological referral service can have a significant clinical impact. Following neurological liaison assessment, 21–63% 9 14–16 19 21 have a change in diagnosis and 21–88% 9 12 13 15 16 18 have a change in management plans—with reduced length of stay 16 20 and reduced inpatient care costs. 17 20 …”

“…In about 60% of neuroscience or neurology centres, neurologists regularly visit the acute medical unit; occasionally, they are based in the unit. 20 However, in a significant number of these centres (21–27%), neurologists do not visit the acute medical unit regularly.…”