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J Neurol Neurosurg Psychiatry 75:406-409 doi:10.1136/jnnp.2003.018010
  • Paper

Provision of 24 hour acute neurology care by neurologists: manpower requirements in the UK

  1. C Carroll,
  2. J Zajicek
  1. Department of Neurology, Derriford Hospital, Plymouth, UK
  1. Correspondence to:
 Dr C Carroll
 Room N16, ITTC Building, Tamar Science Park, Plymouth. PL6 8BX, UK; camille.carrollpms.ac.uk
  • Received 8 May 2003
  • Accepted 9 July 2003
  • Revised 4 July 2003

Abstract

Objectives: The ABN has published standards of care for patients with acute neurological disease. Derriford Hospital provides a 24 hour neurology intake service to a population of 500 000 with the equivalent of four consultants, three specialist registrars (SpRs), and four senior house officers (SHOs) with a 37 bed ward. The authors undertook a prospective study of all neurology admissions to enable calculation of manpower necessary to meet the ABN guidelines.

Methods: All admissions to the neurology department were analysed prospectively for a three month period (March to May 2002).

Results: There were 629 admissions (equating to 2500 per year); data were collected for 93%. 78% of admissions were emergency, 16% elective. The mean number of neurology inpatients at any time was 76, with three (4%) being elective. The main diagnostic categories were stroke (29%), headache syndrome (13%), and epilepsy or seizures (12%). With regard to emergency admissions, 94% were seen by a neurology SHO within 6 hours and 81% by an SpR or consultant within 24 hours. Twenty five percent of emergency admissions were not seen by a consultant. 55% of patients were cared for on non-neurological wards for their entire admission. Median length of stay for stroke patients was 9.5 days, compared with 4 days for other patients. 37% of patients received a neurology follow up appointment. Currently each SpR spends 18 hours per week involved in the care of acute neurology admissions.

Conclusion: Meeting the ABN guidelines will require an increase in total neurology bed provision to at least 15 per 100 000 population, with the equivalent of 3 consultant sessions (11 hours/week). Meeting the European Working Time Directive will require a minimum of 8–10 SpRs working a full shift system, which will have a significant impact on training and other aspects of service delivery.

Footnotes

  • Competing interests: none declared

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