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

Neurological illnesses are a common cause of hospital admissions, yet most patients are not primarily managed by neurologists. Acute neurology service provision varies across the UK. This study aimed to establish the number of neurological admissions during a 2-week period in a district general hospital, as well as the proportion of those patients who were seen by the hyperacute neurology team. This was done by analysing the diagnostic codes. It was established that there was a total of 2,242 admissions during the study period and, of those, 491 (22%) had neurological codes. Analysis of the 491 hospital electronic records revealed that 229 (10%) were truly neurologically relevant and, of those, 14% of patients received an opinion from the neurology team. Therefore, it can be concluded that only a small proportion of acute neurology is currently being seen by neurologists.

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.

Neurology liaison services in the acute medical receiving unit

INTRODUCTION

Guidelines from the Association of British Neurologists and National Health Service Quality Improvement Scotland suggest that neurologists should be involved in the early management of patients presenting to hospital with acute neurological illness.

AIM

We chose to evaluate whether regular neurology review in an acute medical receiving unit in a busy city hospital was feasible, and whether it would have an impact on patient care.

METHODS

Over a 5-week period from Monday to Friday, all neurology patients admitted to an acute medical receiving unit were identified and all headaches and blackouts were reviewed.

RESULTS

Fourteen (24%) were headache patients, 37 (63%) presumed seizure and 8 (13%) had another neurological illness. Diagnosis was made by the admitting physician in six headache patients (43%). The remaining eight headache patients were diagnosed by the visiting neurologist and two physician diagnoses were revised. The diagnosis made by the admitting physician was clarified by the visiting neurologist in 13 blackout patients (35%) and nine other diagnoses were revised (24%). Appropriate outpatient follow-up or transfer was arranged.

CONCLUSION

These results suggest that a daily neurology review service is useful in medical receiving units by clarifying diagnoses, directing tests and limiting inappropriate follow-up.