Abstract

20% of acute medical patients present with neurological symptoms, yet are often managed by non-specialist acute physicians. This district general hospital (DGH) introduced a direct access neurology clinic, to reduce hospital admissions and improve access to neurological expertise for vulnerable patients. Patients would otherwise have been admitted to await ward consultation.

20 ‘Hot’ clinic appointments each week were allocated by administration prior to discharge from the medical admissions unit. All appointments were within 48 hours. Common diagnoses were migraine, first seizure, and non-epileptic attack disorder and rarer presentations included 5 with transverse myelitis, 1 with cerebral vasculitis, and 1 with Hepatitis E related encephalomyelopathy.

243 patients were seen by a Consultant Neurologist in 9 months in this hot clinic, thus saving at least 243 bed days and £73 000. Only 4 of these patients were readmitted. The hot clinic required 4PAs of consultant time split across weekdays, at an estimated cost of £30 000 per annum.

This neurology acute clinic successfully provided front door neurological input, a vital service for GPs and patients, and made approximate annual saving of £70 000. Evidently, every DGH should consider implementing neurology ‘hot’ clinics.