We operate a consultant led ‘post-acute’ model for Acute Neurology service delivery, with Advice and Guidance (an email service for GPs); attendance at twice daily ‘huddle’ meetings on MAU; and inpatient e-referrals. We have two sites, 683 inpatient beds in Gloucester Royal, and 379 in Cheltenham General. 10–15 of these inpatient beds (in Gloucester) are flexibly allocated under neurology.
We received 153 inpatient e-referrals over a 1 month audit (October 2017). 78% of these received an inpatient review (the remaining 22% were managed by email); 97% within 24 hours, 7 days per week; 100% by consultants. This averages 5 referrals per day (range 0–9). Patients can be transferred under neurology when beds are available (49 admissions/month).
The reasons for referral included focal neurological deficits (27%), headache (21%), epilepsy (14%), movement disorders (10%), unexplained loss of consciousness or possible seizure (9%), altered consciousness (8%), neurological infections (3%), and scan abnormalities (3%).
This rapid input is in line with the ABN’s Quality Standard for Unscheduled Care. The referral element of this service requires approximately 1.5–2 PAs on each weekday, and 1 PA on each weekend day. We are also about to start an acute neurology clinic (approx. 20 slots per week).