Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

A survey of acute neurology at a general hospital in the UK

Andrew Cai and Peter Brex
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.10-6-642
Clin Med December 2010
Andrew Cai
Senior house officer in neurology
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Peter Brex
Consultant neurologist, King's College Hospital, London
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
Loading

The Association of British Neurologists (ABN) in their publication Acute neurological emergencies in adults (2002) recommend that all patients with acute neurological disease should be seen by a neurologist within 24 hours. We therefore undertook a study to consider the proportion of patients admitted with neurological symptoms to a district general hospital covering a population of 350,000 to determine what level of access they have to a neurologist.

During a two-week period (22 September 2008 and 5 October 2008) all the accepted medical admissions were reviewed. Patients were grouped under a neurological category if the first differential diagnosis at the most senior review was a neurological disorder, or if the differential was yet unclear at the time of clerking but the presentation was predominantly neurological.

A total of 358 patients were admitted in this period, neurology had the highest proportion of admitted patients (93 patients or 26%). This was followed closely by cardiology (23%) and respiratory (22%). The other specialties made up the remainder (104 patients or 29%) (Fig 1).

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Primary reason for urgent medical admission by specialty.

Of the 93 neurological patients, most (21) were admitted for cognitive disorders, followed by ‘blackouts/seizures’ (19), falls (15), weakness (15), headache (11), dizziness/vertigo (10) and movement disorders (2). The mean age of these neurological patients was 70 (range 21–100); 40% were under 70 years of age; 55 patients were female and 38 were male. Only 10 patients (11%) were referred to the neurology team for specialist advice.

Our findings are similar to previous studies that have reported 19% of inpatients in general hospitals to have neurological symptoms. We were surprised by the low number of patients who were referred to a neurologist. The input of a neurologist has been shown to lead to a change in management of patients in approximately a third of cases.1 It also improves the diagnosis rate and reduces average length of stay.2

Providing a comprehensive enough service to enable neurological review of all patients with neurological symptoms as recommended by the ABN would require a significant increase in resources. The hospital studied has three neurologists who cover the ward referrals during the week with approximately five hours between them allocated in their job plans for this activity. Carroll and Zajicek described the experience in a 24-hour acute neurology unit in Plymouth.3 They concluded that per 100,000 population, 10.8 hours of specialist registrar time and 11 hours of consultant time per week, 15 neurology beds and 90 outpatient appointments would be required. This study was performed before the European Working Time Directive came into force.

Neurologists in the UK are under increasing amounts of pressure to provide outpatient reviews within timelines set out by the government and this is leading to a greater demand for them in a variety of settings. However, the benefits of their expertise in the management of hospital inpatients, in terms of ensuring appropriate investigation, an accurate diagnosis and reducing average length of stay should not be overlooked when planning services.

Footnotes

  • Letters not directly related to articles published in Clinical Medicine and presenting unpublished original data should be submitted for publication in this section. Clinical and scientific letters should not exceed 500 words and may include one table and up to five references.

  • Royal College of Physicians

References

    1. Steiger MJ
    , Enevoldson TP, Hammans SR, Ginsberg L. Influence of obtaining a neurological opinion on the diagnosis and management of hospital inpatients. J Neurol Neurosurg Psychiatry 1996;61:653–4.doi:10.1136/jnnp.61.6.653-a
    OpenUrlFREE Full Text
    1. Forbes R
    , Craig J, Callender M, Patterson V. Liaison neurology for acute medical admissions. Clin Med 2004;4:290.
    OpenUrlFREE Full Text
    1. Carroll C
    , Zajicek J. Provision of 24 hour acute neurology care by neurologists: manpower requirements in the UK. J Neurol Neurosurg Psychiatry 2004;75:406–9.doi:10.1136/jnnp.2003.018010
    OpenUrlAbstract/FREE Full Text
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
A survey of acute neurology at a general hospital in the UK
Andrew Cai, Peter Brex
Clinical Medicine Dec 2010, 10 (6) 642-643; DOI: 10.7861/clinmedicine.10-6-642

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
A survey of acute neurology at a general hospital in the UK
Andrew Cai, Peter Brex
Clinical Medicine Dec 2010, 10 (6) 642-643; DOI: 10.7861/clinmedicine.10-6-642
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Letters to the Editor

  • JAK-inhibition as a therapeutic strategy for refractory primary systemic vasculitides
  • Response
  • Functional disorders and chronic pain
Show more Letters to the Editor

Clinical & Scientific Letters

  • The preference of general practitioners for structured outpatient clinic letters
  • Where there is no resident neurologist: a case for a neurology attachment for acute medicine trainees
  • Early intervention can influence an outcome – time to introduce an alert system for all cancer patients?
Show more Clinical & Scientific Letters

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians