Introduction Patients with Functional Neurological Symptoms (FNS) can present acutely, but many hospitals lack specific pathways or services for them. Outpatient FNS cohorts have been studied, but there is little data regarding acute FNS to inform service improvement.

Method Over an 8 month period at Leeds Teaching Hospitals NHS Trust (UK), the on-call neurology and stroke teams were telephoned regularly. Acute referrals with possible FNS were recorded. Electronic documentation was searched for the following events: symptoms, first presentation, diagnosis, A and E, outpatient clinic, inpatient admission, investigation, and psychological/psychiatric referral. This data was analysed with process mapping software (Fluxicon disco).

Results We present a dynamic care pathway map using real data, showing 205 patients with possible FNS moving through hospital services over time. Our map visualises the temporal relationships between healthcare utilisation, first presentation, diagnosis and therapy. The picture shows high healthcare burden, with incomplete and slow movement towards appropriate therapy (e.g. clear diagnosis documented in only 66%; referral to psychological therapy in 26%).

Conclusion Patients with FNS are regularly referred to acute neurological services in Leeds. Our dynamic map shows a high healthcare burden, and slow or incomplete movement to appropriate care, which suggests potential targets for service improvement.