CAN A RAPID ACCESS NEUROLOGY CLINIC REDUCE A&E ADMISSIONS?
Authors: Peukert Thomas , McDonnell Gavin , Craig John , Shortt Peter 
Published: August 2014

Background

In the past nine years, the number of patients attending the A&E department of the Royal Victoria Hospital Belfast, with neurological complaints has more than doubled.

The number of A&E attendees with neurological complaints is similar to cardiology and higher than gastroenterological complaints. Approximately half of attendees were referred for further investigations or specialist opinion via their primary care physician. Of all attendees only a small number (29%) were referred to or discussed with the neurology department.

More than half of A&E attendees presenting with neurological complaints are admitted, mostly under medical team (95%). The number of patients admitted with neurological complaints is higher than for gastroenterology or cardiology.

Objectives

To pilot a rapid access neurology clinic (RANC) and determine if it is possible to reduce unnecessary hospital admissions of patients with neurological complaints.

Methods

The pilot ran for four weeks in October 2013. Three clinics were held per week with four slots available per clinic; slots were filled directly from senior A&E staff. Only patients that otherwise would have been admitted were allowed to be referred to the RANC.

Results

A total of 45 patients were seen in the RANC. The average waiting time to be seen was 8 days. The two main presentations referred to the RANC were headaches and seizures. The number of CT or MRI scans arranged in the RANC was significantly lower then the number arranged for patients that were admitted. (0.38 scans/patient vs. 1.15 scans/patient). Two-thirds of patients seen in the RANC did not require a follow up under neurology.

Questionnaires were sent out to patients that attended the RANC and A&E staff. The response showed an extremely high satisfactory rate in both groups.

The estimated cost savings by avoiding admissions were calculated as £46,200 during the 4 weeks. This did not include he costs savings due to reduction of MRI/CT scans.

Aside from cost saving, the overall quality of care for patients with neurological complaints is enhanced through rapid access to specialist services.

Conclusion

The results of the pilot study suggest that provision of a RANC can reduce unnecessary hospital admissions for patients with neurological complaints. The pilot study received very positive feedback from A&E colleagues and patients. Regular provision of the service may lead to considerable cost savings.

Compare time period with and without RANC

01/08/13–31/08/13
RANC not in place25/09/13–23/10/13
RANC in placeA+E attendees71496849Neurology patients479436Admitted269211% admitted56.2%48.4%Referred to RANC048Admission avoided028If no RANC available
Admission rate56.2%54.8%

A and E attendances in last 9 years in RVH by medical speciality

YearCardGastroNeuroResp200527211747237124652006235917692292248020072831182225202908200825982247254031502009295920102836328820103103220930503362201133142629363635842012488234014419550420134966383950635714

RVH A&E attendances by speciality since 2005

Neurological symptoms seen in the RANC