Background and aim 5-10% of emergency department (ED) presentations are primarily neurological. We investigated the impact of the introduction of an acute neurology service to the ED, using the same day emergency care (SDEC) model.

Methods We performed a retrospective review of consecutive referrals to a consultant-led service at University College London Hospital during weekday afternoons from 5th May 2021 to 20th Jan 2022.

Results Of 664 Neurology referrals, female sex was more common than male (60% vs 35.8%, p<0.0001, Fig. 1).

Most referrals were from ED Majors (30%, Fig. 2). The most common presenting complaints were headache(n=187), weakness(n=34), dizziness(n=28), and numbness(n=26). Referrers’ working diagnoses included no diagnosis (n=69), unspecified headaches(n=62), migraines(n=42), and stroke(n=23) (Fig. 3). The most common diagnoses after Neurology review were migraines(n=160), vascular events(n=21), functional(n=16), and seizures(n=12) (Fig 4).

Following review, working diagnosis changed in 307(46.2%), and the following planned actions were cancelled: hospital admission in 204(30.7%); stroke referral in 190(28.6%); imaging in 45 and lumbar puncture in 33. 170(25%) cases were fully managed in SDEC which would otherwise have followed the urgent 2-week-wait pathway.

Conclusions Acute Neurology input in the ED had major impacts on working diagnoses, hospital admis- sions, urgent outpatient referrals, and emergency investigations.