Objectives Neurology has been transformed by the recent advances in imaging, most notably CT and MRI scanning, prior to the advent of these technological advances, clinical examination was relied upon to locate the lesion. The role of neurological examination in modern medicine, has been questioned by some, however as health care providers face increasing financial pressure, expensive imaging is likely to be restricted;¹ therefore clinical assessment remains paramount. A full neurological examination requires specialist equipment, which are frequently hard to locate and/or not present on general wards. It was decided that to fully appreciate this clinical problem objective evaluation should be performed.

Methods Seventeen wards, in a district general hospital in Mid Cheshire, were visited by a junior doctor, who assessed the availability and time taken to locate ten items of neurological equipment. This survey encompassed a range of different specialities (surgical, medical and critical care units) to exclude potential confounding factors staff were surveyed about common neurological conditions encountered in their clinical area, and a list of appropriate tools for assessment was compiled. If the required equipment was not located after five minutes of searching, a permanent member of staff on the ward was asked to locate the equipment.

Results All wards visited had an opthalmoscope, and 70% had a tendon hammer. No wards had all the required neurological equipment to fully evaluate the case mix regularly encountered on the ward. On average it took 2.20 minutes to find one out of the ten pieces of neurological equipment, therefore we can extrapolate to perform an entire neurological examination it would take 22 minutes to locate all necessary items.

Conclusion It is evident that the provision of neurological equipment on general wards, is far from desirable, not only is required equipment unavailable, if present it is time consuming to obtain. The impact of this in a time pressured environment, such as on–call shifts, and also on the training of medical students and junior doctors cannot be underestimated. To aid clinical diagnosis of neurological conditions we recommend a solution such as the Walton Neurostand.²