Content area
Full Text
ABSTRACT - Neurological conditions comprise a significant proportion of patient admissions to hospital but, in the majority of cases, are admitted under the care of non-neurological physicians. As a consequence, neurological ward consultations are commonly requested by the admitting medical teams to review diagnoses and management plans. The outcomes of neurological ward consultations were examined and the time required for the referral process recorded by performing a detailed prospective three-month audit of inpatient referrals to the neurology service. The consultations of 120 patients were recorded, categorised and analysed. These consultations were beneficial in the vast majority of cases, with a clear impact on patient diagnoses or management plans. The consultation process was time consuming, however, both in respect of the initial review, but also with follow-up visits. This audit highlights the importance of neurological input in the diagnosis and management of hospital inpatients. The time taken for this process should be resourced appropriately.
KEY WORDS: inpatient consultation, job planning referral, workload
Introduction
Approximately 10% of patients seen in accident and emergency (A&E) departments and 10-20% of patients subsequently admitted to hospital have a primary neurological problem.1-3 The Association of British Neurologists (ABN) proposes that 'a 24-hour neurological service should be available to all patients admitted with acute neurological illness and that all those who do not require immediate intervention should be seen within 24 hours'. The implementation of this proposal, with 24-hour onsite neurology, would require a significant expansion in the number of UK consultants from the current level of 620 to 1,403.4,5
Current government priorities are largely directed at reducing outpatient waiting times and it is likely that, for the foreseeable future, the majority of inpatients with acute neurological problems will remain under the care of physicians who are not neurologists. Neurological ward consultations - in which inpatients are reviewed to contribute to the diagnostic or management process - are commonplace, but the costs and benefits of the process have been subjected to only limited analyses. The process is likely to be time consuming for neurologists, detracting from other clinical duties, and the overall benefit of the consultation process is unclear. A prospective audit was therefore performed on inpatient neurological consultations to evaluate the characteristics of the consultations, the time taken for...