Objectives/Aims To assess the utility of neurology inreach into acute psychiatric hospital wards, through the quantitative evaluation of the case series, and presentation of qualitative experiences of service users and care providers.
Methods All consecutive referrals to a new service delivering neurology inreach to Fulbourn hospital in Cambridge were assessed over the first six months. Patients were categorised according to their primary presentation. Outcomes included whether diagnosis was clarified, whether medication was changed, and whether interventions were made that would otherwise not have occurred. Illustrative case examples are presented.
Results Thirty-five unique patients were assessed over fourteen visits (some on multiple occasions). In 94% of cases a diagnostic opinion and management plan was reached. In 63% of cases medication was changed.
23% of patients presented with a combination of Parkinson’s disease and psychosis. 20% were diagnosed with a non-parkinsonian movement disorder. 14% were diagnosed with a dementia, 14% had epilepsy, and 17% had no neurological abnormality. Importantly, three patients (9%) had an autoimmune encephalitis with a demonstrable antibody.
Cases are presented where neurology inreach facilitated access to treatments that would otherwise have been unavailable, such as rapid plasma exchange and a duodopa infusion pump. Psychiatric interventions such as ECT and clozapine also occurred more rapidly, because of increased diagnostic certainty.
Conclusions Overall, the service has demonstrably delivered patient and healthcare system benefits. It has also been enjoyable for the neurologist to deliver, and well received by the psychiatric inpatient teams. There have been some barriers to delivery, which are discussed, and are mainly to do with commissioning a new service and referral boundaries. Nonetheless, this has been a relatively small input a consultant time (0.5PA) to produce meaningful improvements in patient care, and reductions in length of stay. We advocate that a similar model should be rolled out by cooperation across all acute trusts delivering psychiatric and neurological care, to break down barriers between neurology and psychiatry.
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