Wile D J, Warner J, Murphy W, Lafontaine A L, Hanson A, Furtado S
Can J Neurol Sci. 2014 Mar;41(2):260-4. doi: 10.1017/s031716710001667x.
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.
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.
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).
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.
我们机构设立了一个紧急神经科评估诊所，以改善患者获得及时神经科评估的机会，该诊所已运营了十多年。我们评估了其及时性和影响。
对诊所数据库进行回顾性检查，以了解评估量、等待时间、神经科诊断的趋势，以及神经科评估是否改变了患者的诊断。在实施前后，比较了急诊科神经科评估的频率和因神经科检查而住院的情况。
在第一个十年中，共收到25145份转诊；12460名患者被接纳并在平均3.8个工作日内接受了评估。最常见的问题包括头痛和癫痫（各占20.2%）。总体而言，44.6%的评估导致了对转诊诊断的改变；这一比例因所见到的问题类型而异（从癫痫的10.5%到精神障碍的92.5%）。从开业前到开业后，急诊室神经科评估减少（减少35.7%），因神经科检查而住院的人数减少（从每周4.4次降至每周2.2次，减少50%）。
我们机构的紧急神经科诊所模式在十多年来为超过两百万加拿大人提供了优质服务，包括几天的等待时间；诊所评估影响了诊断和患者护理。
