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. 2020 Apr;10(2):149-155.
doi: 10.1212/CPJ.0000000000000712.

Neurology consults in emergency departments: Opportunities to streamline care

Cindy Zhao  1 , Kathleen Lee  1 , David Do  1
Affiliations

Neurology consults in emergency departments: Opportunities to streamline care

Cindy Zhao et al. Neurol Clin Pract. 2020 Apr.

Abstract

Objective: To use the variations in neurology consultations requested by emergency department (ED) physicians to identify opportunities to implement multidisciplinary interventions in an effort to reduce ED overcrowding.

Methods: We retrospectively analyzed ED visits across 3 urban hospitals to determine the top 10 most common chief complaints leading to neurology consultation. For each complaint, we evaluated the likelihood of consultation, admission rate, admitting services, and provider-to-provider variability of consultation.

Results: Of 145,331 ED encounters analyzed, 3,087 (2.2%) involved a neurology consult, most commonly with chief complaints of acute-onset neurologic deficit, subacute neurologic deficit, or altered mental status. ED providers varied most in their consultation for acute-onset neurologic deficit, dizziness, and headache. Neurology consultation was associated with a 2.3-hour-longer length of stay (LOS) (95% CI: 1.6-3.1). Headache in particular has an average of 6.7-hour-longer ED LOS associated with consultation, followed by weakness or extremity weakness (4.4 hours) and numbness (4.1 hours). The largest estimated cumulative difference (number of patients with the specific consultation multiplied by estimated difference in LOS) belongs to headache, altered mental status, and seizures.

Conclusion: A systematic approach to identify variability in neurology consultation utilization and its effect on ED LOS helps pinpoint the conditions most likely to benefit from protocolized pathways.

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Figures

Figure 1
Figure 1. Disposition of the top 10 chief complaints with a neurology consult
All bars refer to the percent of encounters with the indicated disposition by chief complaint. Only encounters that resulted in neurology consultation in the ED are included. ED = emergency department.
Figure 2
Figure 2. Consultation variability by ED attending and by time of ED arrival
Adjusted by acuity, ED disposition, and sex.
Figure 3
Figure 3. Predictors of ED LOS
Adjusted by acuity, age, sex, arrival hour, ED provider, and chief complaint. LOS = length of stay.
Figure 4
Figure 4. Association of neurology consultation with LOS by chief complaint
Adjusted by ED disposition, sex, age, acuity, arrival time of day, and ED physician. Cumulative difference = expected time saved if LOS with consult matched LOS without consult (hours) and is calculated by multiplying the number of consultations with the adjusted difference in LOS between patients with and without consultation. LOS = length of stay.
See this image and copyright information in PMC

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