Referrals, Wait Times and Diagnoses at an Urgent Neurology Clinic over 10 Years

Abstract

Background:An urgent neurology assessment clinic was created at our institution to improve access to prompt neurological assessment, and has been in operation for over a decade. We assessed its timeliness and impact.Methods:The clinic database was examined retrospectively for trends in the volume and waiting time to assessments, neurologic diagnoses, and whether neurologic assessment changed patients’ diagnoses. Before and after implementation, the frequency of emergency department neurology assessments and hospital admissions for neurological investigation were compared.Results:In the first decade, 25145 referrals were received; 12460 patients were accepted and assessed within an average of 3.8 working days. The most common problems seen included headache and seizure (20.2% each). Overall, 44.6% of assessments resulted in a change to the referring diagnosis; this proportion varied by the type of problem seen (from 10.5% for seizures to 92.5% for psychiatric disturbances). From the pre- to post-opening periods, there were fewer emergency room neurological assessments (35.7% reduction) and fewer hospital admissions for neurological investigation (4.4/week to 2.2/week, 50% reduction).Conclusions:The urgent neurology clinic model at our institution has provided excellent service, including wait times of a few days, to a catchment of over two million Canadians for over a decade; clinic assessments have affected diagnoses and patient care.

Fast Neuro

“…The other study reports on a rapid access neurology clinic. 11 A retrospective record review showed that the wait time for an appointment over a 10-year period was 3.8 days. Overall, 44.6% of assessments resulted in a change to the referring diagnosis.…”

“…20,24 Myriad studies, including several described in this discussion, also show that neurology consultation often changes the ED diagnosis within the first day of admission or on rapid follow-up. 11,13,17,[22][23][24][25][26] By providing assurance that the neurology department will arrange for reliable rapid access outpatient appoints, the UCLA Fast Neuro model could enable emergency physicians to more confidently defer care to the outpatient setting, while also providing patients with the most appropriate care for their conditions. Such redirection would reserve resources for true emergencies and inpatient neurologic care for those who need it, while also reducing disparities and improving patient satisfaction and other outcomes.…”

Prospective validation study of an epilepsy seizure risk system for outpatient evaluation

“…Nearly one‐third of referrals in neurology are for new‐onset or breakthrough seizures . Neurologists are often provided with the date of a breakthrough seizure or increase in seizure frequency, and asked to determine whether this reflects an actual change in the underlying propensity toward seizures warranting intervention change .…”

Rapidly Progressive Dementia in the Outpatient Clinic: More Than Prions

“…1–5,8,9 These approaches prioritize testing using measures of varying sensitivity and specificity for the diagnosis of CJD, including magnetic resonance (MR) imaging, 10 electroencephalogram (EEG), 11 and cerebrospinal fluid (CSF) biomarkers (i.e., total-tau, 14-3-3 and real-time quaking-induced conversion [RT-QuIC] 12–14 ). The prevalence of specific causes of RPD in a given practice environment are expected to vary with center- (e.g., level of care provided, academic affiliation, referral base 3,7 ), practitioner- (e.g., sub-specialization, clinic wait times 15 ), and patient-specific factors (e.g., age, risk factors and exposures 16,17 ). Accordingly, it remains unclear whether existing approaches are applicable to the diagnosis of RPD in patients assessed in lower-acuity outpatient settings, where the majority of neurological care is delivered.…”