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Irish Journal of Medical Science (1971 -)

, Volume 185, Issue 3, pp 611–616 | Cite as

Should we call the neurologist? The value and cost of a growing neurology consultation service

  • N. Broderick
  • C. Farrell
  • N. Tubridy
Original Article

Abstract

Background

St Vincent’s University Hospital has an established neurology consultation service. Referral volumes have been growing. The Department regularly reviews its service to monitor changes and seek improvements.

Aims

We sought to determine the impact of the growing service on patient care, on the department itself in delivering the service, and on inpatient admission trends.

Methods

We reviewed the electronic referral forms of all consults seen over a 9-week period in 2014 (n = 213). We recorded the source of each consult, demographic information, clinical presentation, time from referral to consult, and outcome. We compared the consult list to inpatient admissions list to determine the proportion admitted from consults. We compared our results to previous reviews by this and other neurology departments in Ireland.

Results

Three quarters of neurology consults relate to acute admissions. Patients are all seen within one working day of referral. A significant change in management (83.6 %) resulted from the majority of consults. Consultants see an average of 4.8 (range 0–10) consults per day, needing up to 7.5 h per day to deliver the service. One-third of the department’s inpatients come from consults.

Conclusions

The service significantly benefits patient care. The increasing number of consults will require increased resources and/or service reorganisation to maintain the current level of service.

Keywords

Neurology Referrals Inpatients Consultations Liaison 

Notes

Conflict of interest

Dr. Farrell has nothing to disclose. Dr. Broderick has nothing to disclose. Professor Tubridy has nothing to disclose.

References

  1. 1.
    Roberts K, Costelloe D, Hutchinson M et al (2007) What difference does a neurologist make in a general hospital? Estimating the impact of neurology consultations on in-patient care. Ir J Med Sci 176:211–214CrossRefPubMedGoogle Scholar
  2. 2.
    Ali E, Chaila E, Hutchinson M et al (2010) The ‘hidden work’ of a hospital neurologist: 1000 consults later. Eur J Neurol 17:e28–e32CrossRefPubMedGoogle Scholar
  3. 3.
    Costello D, Renganathan R, O’Hare A et al (2005) Audit of an inpatient neurology consultation service in a tertiary referral centre: value of the consulting neurologist. Ir J Med Sci 98(5):134–137Google Scholar
  4. 4.
    Costelloe L, O’Rourke D, Monaghan TS et al (2011) Liaison neurologists facilitate accurate neurological diagnosis and management, resulting in substantial savings in the cost of inpatient care. Ir J Med Sci 180:395–399CrossRefPubMedGoogle Scholar
  5. 5.
    Ramírez-Moreno JM, Ollero-Ortiz A, Gómez-Baquero MJ et al (2013) Longitudinal study of in-hospital consultations with neurology in a tertiary hospital. A health care activity on the increase. Neurología 28(1):9–14CrossRefPubMedGoogle Scholar
  6. 6.
    Peukert T, McDonnell G, Craig J et al (2014) Can a rapid access neurology clinic reduce A&E admissions? Emerg Med J 31(9):775–791CrossRefGoogle Scholar
  7. 7.
    Rodríguez Cruza PM, Pérez Sánchez JR, Cuello JP et al (2014) Workload of on-call emergency room neurologists in a Spanish tertiary care centre. A one-year prospective study. Neurología 29(4):193–199CrossRefGoogle Scholar
  8. 8.
    Rudolf J, Dermitzakisa EV, Kyriazopoulou E et al (2010) Workload of the emergency room neurologists and the neurological inpatient department in a Greek tertiary care hospital. Clin Neurol Neurosurg 112:332–335CrossRefPubMedGoogle Scholar
  9. 9.
    de Falco FA, Sterzi R, Toso V et al (2008) The neurologist in the emergency department. An Italian nationwide epidemiological survey. Neurol Sci 29:67–75CrossRefPubMedGoogle Scholar
  10. 10.
    ABN Working Party on Care of Acute Neurological Emergencies (2002) Acute neurological emergencies in adults. http://www.theabn.org/downloads/AcuteNeurology.pdf
  11. 11.
    Carroll C, Zajicek J (2004) Provision of 24 hour acute neurology care by neurologists: manpower requirements in the UK. J Neurol Neurosurg Psychiatry 75:406–409CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Moeller JJ, Kurniawan J, Gubitz GJ (2008) Diagnostic accuracy of neurological problems in the emergency department. Can J Neurol Sci 35:335–341CrossRefPubMedGoogle Scholar
  13. 13.
    Warlow C, Humphrey P, Venables G (2002) UK Neurologists and the care of adults with acute neurological problems. Clin Med 2:436–439CrossRefGoogle Scholar
  14. 14.
    Moulin T, Berger E, Lemounaud P et al (2000) Emergency consultations in the university hospital setting: contribution of the neurologist to inpatient management. Rev Neurol 156:727–735Google Scholar
  15. 15.
    Hillen ME, Sage JI (1996) Proving the worth of neurologists. Neurology 46:276–277CrossRefPubMedGoogle Scholar
  16. 16.
    Royal College of Physicians (2011) Local adult neurology services for the next decade. Report of a working party. RCP, LondonGoogle Scholar
  17. 17.
    Department of Health and Children (2012) Future health, DublinGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2015

Authors and Affiliations

  1. 1.Department of NeurologySt. Vincent’s University HospitalDublin 4Ireland

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