teleneurological support for emergency department

Conditions: Emergencies; Neurologic Disorder

Summary: open-label, non-inferiority, teleconsultation with televisit study to compare efficacy, safety and users satisfaction of a teleneurological support versus "in person" neurological examination in the emergency department

the investigtors are going to perform an interventional, open-label study on the use of teleconsultation in the emergency department focused on neurological diseases other than stroke (for which a specific protocol already exists) in two hospitals of modena province, italy. the study is aimed at developing a remote neurological consultancy system (teleconsultation) for patients with acute neurological symptoms in charge of hospital facilities without 24-hour availability of neurologist consultant. pilot project setting: a) ed of modena policlinico hospital in the afternoon, night, and public holidays, time windows in which the neurologist consultant is not present at policlinico hospital; b) ed of mirandola hospital. the project (enrolment) is expected to be developed over a period of 6 months in which 100 patients will be enrolled. the primary objective is to assess whether a teleneurological evaluation and support for the emergency department can guarantee a faster but qualitatively not inferior diagnostic/therapeutic work-up if compared with in person examination, assuring the availability of all the necessary examinations and treatments with a consistent time reduction. secondary objectives: to determine if the usage of a teleconsultation physician for neurological evaluation compared to a conventional physician "de visu" in urgent but non-life-threatening neurological cases, is superior regarding 1) effect evaluation, 2) process evaluation, and 3) cost-benefit analysis. outcome and process indicators will be assessed and compared in the following groups: * experimental group (cases): a) patients who access the policlinico hospital ed in the afternoon and night-time and on holidays; b) patients who access the mirandola hospital ed during the period of the study. * control groups: a) retrospectively collected data on neurological consultation performed by ocb neurology for policlinico hospital patients in the same time slots in the same months of the last two years.; b) retrospectively collected data on neurological consultation performed by carpi neurology for mirandola hospital patients in the same time slots in the same months of the last two years.

Eligibility criteria:
inclusion criteria: * patients aged \> 18 years * symptoms related to possible acute / subacute neurological pathology, or worsening of known neurological pathology, for which the ed physician considers neurological consultation indicated / necessary. * signing of informed consent to remote neurological evaluation. exclusion criteria: * all life-threatening emergency cases, where the study procedure would interfere with clinical practice * patients with known neurological pathology or with clinical severity to such an extent that the need for admission to ocb/carpi neurology unit or to the internal wards of the policlinico is immediately evident. * refusal of the patient/caregiver to perform remote neurological evaluation.