A critical appraisal of in-patient neurological services in a subregional centre.

A computer database was established for the medical audit of admissions to the North Manchester General Hospital neurology unit. Over a six-month period, 277 patients completed 300 hospital stays. A higher proportion of patients were admitted from the North Manchester District compared with the peripheral districts served by the unit, suggesting that more neurology in these areas was performed by general physicians. This supports claims for an increase in the number of neurologists to improve the quality of service at district level. The introduction of a programmed investigation unit, closed at weekends, would allow financial savings since 60% of cases did not require a bed at the weekend. It would also allow more efficient pre-booking of investigations. The diagnostic yields from routine B12 and folate levels, syphilis serology, thyroid function tests, chest radiography and electrocardiography were low and should be replaced by more selective investigations. Savings might also be made by performing the 38% of myelograms restricted to the lumbar region in the out-patient department. The introduction of out-patient magnetic resonance imaging will make significant savings by obviating the need for many of the inpatient myelograms which were required in 55 patients. The simple and relatively inexpensive technology used in this study provided medical staff with valuable information on which to base changes in practice and evaluate their consequences.