Bierrum William, Spencer Jonathan Ian, Macarimban Roberto, Shirazi Ayala, Dethabrew Agampodi-Umanda, See Isaiah, Henry Alun Marc, Schlattl Anne, Alim-Marvasti Ali-Jesus, Balaratnam Michelle, Chandratheva Arvind, Baruah Tim, Simister Robert, Haider Salman
Neurology Same Day Emergency Care, University College London Hospitals NHS Foundation Trust, London, UK
Neurology Same Day Emergency Care, University College London Hospitals NHS Foundation Trust, London, UK.
BMJ Open Qual. 2024 Dec 31;13(4):e003036. doi: 10.1136/bmjoq-2024-003036.
There are various models for acute neurology services in the UK, with considerable variation in practice. Patients are often admitted unnecessarily for neurology review, leading to delay in diagnosis and treatment. Alternative models, such as the Neurology Same Day Emergency Care service (Neuro-SDEC) at University College London Hospital provide a pathway that can prevent admissions and streamline patient care. Headache is one of the commonest presenting symptoms in acute neurology.This study compared the impact of Neuro-SDEC on the care for patients presenting with headache against the standard pathway.A prospective audit was undertaken from November - December 2023 to evaluate all appropriate patients seen by the Neuro-SDEC service or admitted to the ward. For Neuro-SDEC patients, each case was reviewed to see whether an admission, lumbar puncture or neurology outpatient referral was avoided. For admitted patients, length of inpatient stay, time to neurology review and discharge diagnosis was recorded.Fifty-one patients were seen by Neuro-SDEC, twenty-five of whom would have been admitted to hospital on the standard pathway. Thirty general neurology outpatient clinic referrals were prevented and 5 patients avoided a lumbar puncture. In 45% of cases, the working diagnosis changed after the patient was seen by the Neuro-SDEC team. There were seven admitted patients not seen by the service with a combined length of stay of 17 bed days. The average wait time for inpatient neurology review was 42 hours. 3 admitted patients underwent a lumbar puncture. 2 patients were referred on to neuro-SDEC to enable an earlier discharge from hospital. Migraine was the most common final diagnosis in both groups.This study highlights that Neuro-SDEC is effective at reducing hospital admissions, as well as unnecessary tests and referrals to generalneurology outpatients. For admitted patients, the service enabled earlier discharge from hospital and reduced length of stay.
英国有多种急性神经病学服务模式，实际操作存在很大差异。患者常常因不必要的神经病学评估而入院，导致诊断和治疗延误。其他模式，如伦敦大学学院医院的神经病学当日急诊护理服务（Neuro-SDEC），提供了一种可以避免入院并简化患者护理的途径。头痛是急性神经病学中最常见的症状之一。本研究比较了Neuro-SDEC与标准途径对头痛患者护理的影响。于2023年11月至12月进行了一项前瞻性审计，以评估Neuro-SDEC服务接诊或收治入院的所有合适患者。对于Neuro-SDEC患者，审查每个病例以确定是否避免了入院、腰椎穿刺或转介至神经病学门诊。对于收治入院的患者，记录住院时间、神经病学评估时间和出院诊断。Neuro-SDEC接诊了51名患者，其中25名患者按照标准途径本应入院。避免了30次普通神经病学门诊转介，5名患者避免了腰椎穿刺。在45%的病例中，患者经Neuro-SDEC团队诊治后工作诊断发生了变化。有7名收治入院的患者未接受该服务，住院总时长为17个床日。住院神经病学评估的平均等待时间为42小时。3名收治入院的患者接受了腰椎穿刺。2名患者被转介至Neuro-SDEC以便更早出院。偏头痛是两组中最常见的最终诊断。本研究强调，Neuro-SDEC在减少住院、不必要的检查以及转介至普通神经病学门诊方面有效。对于收治入院的患者，该服务能够使患者更早出院并缩短住院时间。
