How Is Functional Neurological Disorder Managed in Australian Hospitals? A Multi‐Site Study Conducted on Acute Inpatient and Inpatient Rehabilitation Wards

Abstract

Background Successful management for functional neurological disorder (FND) requires multidisciplinary involvement starting with providing a definitive diagnosis. Objectives To observe clinical management of patients with FND during hospital admission. Methods A prospective observational study was conducted over six Australian hospitals over a 4‐month period. Data collected included patient demographics, communication of the diagnosis of FND, access to the multidisciplinary team, hospital length of stay (LOS), and emergency department (ED) presentations. Results A total of 113 patients were included. Median LOS was 6 (interquartile range, 3–14) days. Thirty‐five (31%) presented to ED with 9 (8%) re‐presenting two or more times after hospital discharge. Total hospital utilization cost was AUD$3.5million. A new diagnosis was made in 82 (73%) patients. Inpatient referrals were made to neurology (81, 72%), psychology (29, 26%), psychiatry (27, 24%), and physiotherapy (100, 88%). Forty‐four (54%) were not told of the diagnosis. Twenty (24%) did not have their diagnosis documented in their medical record. Of the 19 (23%) not reviewed by neurology on non‐neurosciences wards, 17 (89%) did not have their diagnosis communicated and 11 (58%) did not have it documented. Twenty‐five (42%) referred to neurology were not provided with a diagnosis. Conclusions Current gaps in service provision during inpatient hospital admissions in Australia include low rates of communication of a diagnosis, particularly when patients are not located on a neurosciences ward, and limited and variable access to inpatient multidisciplinary teams. Specialized services are needed to improve education, clinical pathways, communication, and health outcomes while reducing healthcare system costs.

Delivering a Specialised Best Practice Service for People with Functional Neurological Disorder: An Australian Qualitative Descriptive Study

“…A UK study confrmed that non-coding is very common in FND [17]. In Australia, a prospective observational study by Petrie and colleagues [18] found that 89% of inpatients managed on nonneurosciences wards did not have a diagnosis communicated and 58% did not have it documented. Tese challenges may result from the reluctance to provide a formal diagnosis, FND being wrongly viewed as a diagnosis of exclusion, and poor knowledge of FND among non-neurology teams.…”

The role of neuropsychology in the care of patients with functional neurological symptom disorder

“…Multiple efforts have been made to improve outcomes for patients with FNSDs, including (1) enhancements to medical education (Barnett et al, 2022;Rawlings & Reuber, 2018), (2) guidelines for communication with patients (Finkelstein et al, 2022;Rockliffe-Fidler & Willis, 2019), (3) the development of evidence-based psychotherapeutic interventions (Goldstein et al, 2020;LaFrance et al, 2014), and (4) increased interdisciplinary care (Lidstone et al, 2020;Petrie et al, 2023). Items 1 and 4 are expanded upon below because of their relevance to neuropsychologists.…”