Hyperacute neurology at a regional neurosciences centre: a 1-year experience of an innovative service model

Abstract

St George's Hospital hyperacute neurology service (HANS) is a comprehensive, consultant-delivered service set in a teaching hospital regional neuroscience centre. The service addresses deficiencies in acute neurological care previously highlighted by the Royal College of Physicians and the Association of British Neurologists. HANS adopts a disease-agnostic approach to acute neurology, prioritising the emergency department (ED) management of both stroke and stroke mimics alike alongside proactive daily support to the acute medical unit and acute medical take. Rapid access clinics provide a means to assess ambulatory patients, providing an outlet to reduce the burden of referral from primary care to acute medicine. This paper reports the results from the first year of the service. Admission was avoided in 25% of the cases reviewed in the ED. Compared to historic data, there was a significant improvement in the length of stay for non-stroke disorders while the occupancy of stroke beds by non-stroke cases reduced by 50%. The configuration of this service is replicable in other neuroscience centres and provides a framework to reduce the barriers facing patients who present with acute neurological symptoms.

Keywords: Hyperacute neurology service; ambulatory neurology; neurology hot clinics; rapid access neurology clinics.

Fig 1.

Pie chart representing the referral caseload according to clinical area of review.

Fig 2.

Histogram representing length of stay for all cases referred to hyperacute neurology service.

Fig 3.

Bar chart depicting the frequency of neurological disorders reviewed by hyperacute neurology service.

Fig 4.

Diagnostic classification of cases reviewed by hyperacute neurology service as a function of mean length of stay. All individual diagnoses contributing to less than 1% of the total caseload are collapsed into ‘other’. The bar graph represents a colour continuum such that diseases represented by white/green bars are associated with shorter length of stay compared to other conditions.

Fig 5.

Length of stay data for patients reviewed via the hyperacute stroke pathway, with length of stay >48 hours, classified by area of admission. 'Other admissions' refers to admissions to a medical or surgical specialty following an initial review for suspected hyperacute stroke.

Fig 6.

Qualitative differences between non-stroke diagnoses (stroke mimics) admitted to the hyperacute stroke unit (upper) compared to medical wards (lower).

Fig 7.

Diagnoses of patients seen in neurology hot clinics, stratified by source of referral.