The hyperacute neurology team

Editor – Nitkunan et al’s¹ interesting article outlines some innovative ideas to ensure that patients are promptly seen by neurologists after admission to a district general hospital. They highlight the role of an acute neurology nurse co-ordinator and the advantages of a service being based close to the acute medical unit.

Our district general hospital also provides a 5-day service, with patients being seen on the same day if referred before 2 pm. There has been a similarly marked increase in number of referrals to the team. The number of referrals increased by 38% between the first six months of 2014 and the comparable period in 2015, were static to 2016, but increased by a further 22% in the first half of this year.

In response to this growing demand we introduced another individual who could be considered when constructing a hyperacute neurology team – a neurology clinical fellow. This would typically be an individual who has completed Core Medical Training and who is interested in obtaining further experience in neurology. They can provide an easily accessible liaison point with medical teams and can help provide prompt review even with rising referral numbers. Indeed, from January to July 2017, after introduction of the neurology clinical fellow, only 5.1% of patients were not seen on the day a referral was received. In contrast in 2015 and 2016 10.2% and 10.9% reviews were delayed for referrals in the first half of the year.

For such a position to succeed considerable input from consultants is needed, particularly given the fellow’s possible lack of experience in neurology. The consequences of inadequate supervision have been highlighted elsewhere.² The fellow may not have the administrative skills of a neurology nurse co-ordinator but they bring other attributes.

Nitkunan et al found that siting their hyperacute neurology team close to the acute medical unit allowed an approachable referral system to be created. A hospital’s layout may make this difficult, and we instead have a computerised referral system which also avoids a formal referral approach. Designing acute neurology care may require different solutions across the NHS.

Conflicts of interest

No conflicts of interest to declare.