A dedicated neurologist at the emergency department during out-of-office hours decreases patients’ length of stay and admission percentages

Linden, Margareta; Brand, Crispijn L van den; Wijngaard, Ido R. van den; Beaufort, Roeline A Y de; Linden, Naomi van der; Jellema, Korné

doi:10.1007/s00415-018-8734-x

Cited by 9 publications

(13 citation statements)

References 18 publications

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“…During the study period, 27% of all the patients who visited our ED used a public ambulance. The proportion was significantly higher among patients with neurological symptoms in our study (50.6%) as well as in a study by Lindane et al (40.9%) [ 3 ]. Our study’s higher ambulance utilization rate is understandable because dizziness, motor weakness, altered mental status, and seizures accounted for 80% of the chief complaints.…”

Section: Discussionsupporting

confidence: 77%

“…Early intervention by a neurologist is needed to diagnose patients with neurologic symptoms at an early stage and provide accurate initial treatment in the ED. Studies have demonstrated that a dedicated neurologist in the ED reduced the length of stay and the hospital admission rate [ 3 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Neurological symptoms in emergency department (ED) settings vary on a spectrum of presentation and diagnosis. Approximately 9–15% of patients admitted to the ED have neurological symptoms, accounting for a significant proportion of the patients visiting the ED [ 1 , 2 , 3 ]. However, neurology is still considered a complex and unknown area for most doctors [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

Jung

Kim

et al. 2021

IJERPH

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We aimed to evaluate the overall clinical characteristics of patients treated by a neuro-emergency expert dedicated to the emergency department (ED) as an attending neurologist during the COVID-19 pandemic. We included adult patients who visited the ED between 1 January and 31 December 2020 and were treated by a neuro-emergency expert. We retrospectively obtained and analyzed the data on patients’ clinical characteristics and outcome. The neuro-emergency expert treated 1155 patients (mean age, 62.9 years). The proportion of aged 18–40 years was the lowest, and the most common modes of arrival were public ambulance (50.6%) and walk-in (42.3%). CT and MRI examinations were performed in 94.4 and 33.1% of cases, respectively. The most frequent complaints were dizziness (31.8%), motor weakness (24.2%), and altered mental status (15.8%). The ED diagnoses were acute ischemic stroke (19.8%), benign paroxysmal positional vertigo (14.2%), vestibular neuritis (9.9%), and seizure (8.8%). The mean length of stay in the ED was 207 min. Of the patients, 55.0% were admitted to the hospital, and 41.8% were discharged for outpatient follow-up. Despite the longer stay and the complexity and difficulty of neurological diseases during the COVID-19 pandemic, the accurate diagnosis and treatment provided by a neuro-emergency expert can be presented as a good model in the ED.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

Jung

Kim

et al. 2021

IJERPH

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“…The five attending medical specialists are involved in patients’ assessment on arrival and they perform direct on-site supervision. This change was trialled for 10 weeks in 2016 and showed an overall decrease in LOS with large variability by specialty [28, 29]. The residents kept working as usual.…”

Section: Methodsmentioning

confidence: 99%

The impact of a multimodal intervention on emergency department crowding and patient flow

Linden

Ufford²,

Linden

2019

Int J Emerg Med

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Objective The objective of this study is to assess the impact of a multimodal intervention on emergency department (ED) crowding and patient flow in a Dutch level 1 trauma center. Methods In this cross-sectional study, we compare ED crowding and patient flow between a 9-month pre-intervention period and a 9-month intervention period, during peak hours and overall (24/7). The multimodal intervention included (1) adding an emergency nurse practitioner (ENP) and (2) five medical specialists during peak hours to the 24/7 available emergency physicians (EPs), (3) a Lean programme to improve radiology turnaround times, and (4) extending the admission offices’ openings hours. Crowding is measured with the modified National ED OverCrowding Score (mNEDOCS). Furthermore, radiology turnaround times, patients’ length of stay (LOS), proportion of patients leaving without being seen (LWBS) by a medical provider, and unscheduled representations are assessed. Results The number of ED visits were grossly similar in the two periods during peak hours (15,558 ED visits in the pre-intervention period and 15,550 in the intervention period) and overall (31,891 ED visits in the pre-intervention period vs. 32,121 in the intervention period). During peak hours, ED crowding fell from 18.6% (pre-intervention period) to 3.5% (intervention period), radiology turnaround times decreased from an average of 91 min (interquartile range 45–256 min) to 50 min (IQR 30–106 min., p < 0.001) and LOS reduced with 13 min per patient from 167 to 154 min ( p < 0.001). For surgery, neurology and cardiology patients, LOS reduced significantly (with 17 min, 25 min, and 8 min. respectively), while not changing for internal medicine patients. Overall, crowding, radiology turnaround times and LOS also decreased. Less patients LWBS in the intervention period (270 patients vs. 348 patients, p < 0.001) and less patients represented unscheduled within 1 week after the initial ED visit: 864 (2.7%) in the pre-intervention period vs. 645 (2.0%) patients in the intervention period, p < 0.001. Conclusions In this hospital, a multimodal intervention successfully reduces crowding, radiology turnaround times, patients’ LOS, number of patients LWBS and the number of unscheduled return visits, suggesting improved ED processes. Further research is required on total costs of care and long-term effects.

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“…In this context distinguished symptoms related to internal medical conditions from those of neurological diseases are often really challenging. A recent published report showed that the presence of a neurologist in ER reduced the length of stay, brain imaging number and hospital admission rate for neurologic patients [2]; however other older reports showed contradictory results concerning hospitalization rate for patients receiving specialist consultation, the use of advanced imaging and length of stay [3]. Commonly neurological emergency situations are reported mainly in the context of CVD, head trauma and seizures, conditions that may present high mortality and costs arising from acute management and long-term care.…”

Section: Introductionmentioning

confidence: 99%

The Neurologist in the Emergency Room: Prospective Study of the Neurological Emergency Group in Lombardia

Delodovici¹,

Mauri²,

Meneri³

et al. 2019

JHS

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Purpose of the work was to quantify the workloads and the neurologist's commitment in ER, to verify the management of urgencies and appropriateness of neurological counseling requests. Neurologic emergencies are frequent in elderly patients and are associated with high morbidity and mortality. Due to the aging population, neurologic pathologies in emergency room (ER) are widely expected to increase. The role of the neurologist in this context is controversial. Methods: in 14 operative units of neurology a prospective collection of neurological evaluations in ER was carried out using boards of detection of the most frequent neurological clinical pictures seen in the course of a week. Data were collected from 738 cases. Attention was focused on cerebrovascular diseases (CVD), impairment of consciousness, epilepsy, headache, dizziness, head trauma and disorders of the peripheral nervous system (PNS). Achievements: neurological consultations were on average 5% of total accesses to ER. The most common pathology seen was ischemic stroke. After counseling most patients were discharged home. The CVD required the greatest commitment to the specialist. The usefulness of the specialized neurological "filter" has been confirmed in a non-simple operative context, aimed at optimizing the appropriateness of the hospitalization and the economy of the diagnostic path.

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A dedicated neurologist at the emergency department during out-of-office hours decreases patients’ length of stay and admission percentages

Abstract: In our hypothesis-generating study, a dedicated neurologist present at the ED during out-of-office hours was associated with decreased patients' LOS and a decreased admission percentage, indicating increased decisiveness when the neurologist is present at the ED.

Cited by 9 publications

References 18 publications

Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

The impact of a multimodal intervention on emergency department crowding and patient flow

The Neurologist in the Emergency Room: Prospective Study of the Neurological Emergency Group in Lombardia

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