The Worth of Neurology Consults in the Emergency Room - Quality Improvement in an Urban University-affiliated Hospital Setting
Yaqian Xu1, Roopa Sharma1, Maria Andreina Hernandez1, Machteld Hillen1
1Rutgers New Jersey Medical School
Objective:

To evaluate the usefulness of neurology consults in the emergency room (ER) in a large urban university hospital.

Background:
As the healthcare system shifts towards more managed care, the role of specialists in the hospital setting is changing. We started a quality improvement project aiming to understand the value of neurology consults and their contribution to patient management in the ER.
Design/Methods:
We retrospectively reviewed general neurology consults ordered by the ER in the first 3 months of 2022. Consults were defined as useful if the patients were admitted to the neurology service; or if neurologists recommended additional tests or changes in treatment, which were followed by the consulting ER team.
Results:

From January through March 2022, 258 general neurology consults were requested from the ER. Of these consults, 51 (19.8%) led to inpatient admissions under the general neurology service, 116 (45%) were discharged directly from the ER, and the remainder were admitted to another service. Of the 116 patients that were discharged from the ER, 12 left prior to being seen. In the remaining 104 patients, neurologists recommended additional testing in 43 patients (41.3%). Of these, tests were not conducted in 9 (20.9%) , showed negative results in 24 (55.8%), and yielded clinically significant results in 10 (23.3%) patients. Neurologists recommended changes in treatment in 35 (33.7%) patients, and the changes were executed in 30 patients at discharge (86%). In one case recommendations for both testing and change in treatment were not carried out. In our patients discharged from the ER, neurology consult did not offer recommendations for additional tests or changes in treatment in 41 cases, while our recommendations were not followed in another 13 patients. Fifty consults (48.1%) led to a change in patient management.

Conclusions:

Neurology consults changed patient care in almost half of of patients discharged directly from the ER.

10.1212/WNL.0000000000205539