Abstract

Aneurin Bevan University Health Board (ABUHB) provides for a population of 6 40 000 in South East Wales, in addition to South Powys. The large geographical area contains 3 sites with acute unselected medical intake as well as 3 other hospitals. The neurology department, comprising 6 consultants (1 stroke/neurology), 1 associate specialist and 1 trainee, is based in Newport. Service evaluation (2013) revealed that 1 in 6 neurology clinic appointments were used to see patients discharged from acute medicine, with a median waiting time of 14 weeks. In 2015 the ‘Neurologist of the Week’ service was launched; 5 consultants participate on a weekly rota. Routine work is cancelled and replaced with a 10 DCC (~40 hours) acute neurology week. This includes 3 acute clinics (each 3 patients), daily MAU round for the largest site, and a triage and advice service for primary and secondary care. Visits to other hospital sites are made when needed. The service has led to significant improvements in quality of care, neurology training and undergraduate teaching and is highly valued by colleagues. Repeated evaluations show ~55% of acute clinic patients are discharged, with ~40% of appointments preventing or shortening an admission. Diagnosis is significantly changed in ~40% of consultations.