BackgroundNeurology patients with complex diagnoses in a busy tertiary centre can undergo multiple investigations to reach a diagnosis and are usually discharged with pending results, as tests can take a considerable amount of time to be processed (and released).AimWe set up a Virtual Clinic to follow-up patients’ results post discharge to avoid loss to follow up and improve safety of patient care.MethodsWe identified a significant proportion of neurology inpatients who were not followed-up efficiently (30.8% over 3-month-period) and addressed this issue by initiating a Virtual Clinic. The clinic was run weekly by neurology junior doctors, with protected clinic hours. The outcome of the clinic was communicated to the referring neurology consultant. We compared the follow up rates in the three months pre-clinic (October to December 2019) to the three months after setting up the clinic (January to March 2020).ResultsUsing the PDSA methodology, we successfully managed to increase the follow-up for outstanding investigations to 68.8% from 30.8% (pre-clinic setup), via the implementation of the Neurology Virtual Clinic. We re-audited for another three-month period using the same methodology. For the period September to November 2020, this percentage increased further to 73.68%.ConclusionThis new service was effective at improving test result monitoring and decreased the number of investigations that were not followed up promptly. Most importantly improved the safety of our patients’ care.
A 36-year-old Spanish man, with a background of ketamine use, presented with a 10-day history of severe headache, photophobia, nausea, unsteadiness and slurring of speech. His CT head was normal. CSF white cell count was 151 (lymphocytes), protein 0.7, glucose 2.3 (serum 3.6). He was treated with IV acyclovir for two weeks with no clinical improvement.On examination he remained distressed by headache and photophobic with severe dysarthria, bidirec- tional nystagmus and ataxia.Blood tests were normal or negative including HIV, serology for syphilis, mycoplasma, lyme and brucella, ANA, ENA, dsDNA, ANCA, ACE, LGI1 and NMDA antibodies, anti-Hu, Ri and Yo. IGRA was positive. MRI brain scan was normal. Serial lumbar punctures showed a variable CSF white cell count, with a negative extended virology panel, TB PCR, bacterial cultures, cytology and immunophenotyping.There was no improvement with pulsed steroids or antimicrobial cover for listeria. After 5 plasma exchanges there was some improvement in his CSF white cell count and headache, but he remained very ataxic.An extended paraneoplastic panel revealed positive anti-Tr antibodies. This is a well recognised cause of paraneoplastic cerebellar degeneration, normally associated with Hodgkin’s lymphoma. There have been no previous reported cases of anti-Tr antibodies associated with meningitic symptoms.
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