Establishing a Rapid Access Post-hospitalization Neurology Clinic at an Urban Tertiary Care Center
Objective:
To outline the creation of a rapid access post-hospitalization (RAPH) neurology clinic and its impact on transitions of care.
Background:
Hospitalized neurology patients often require further outpatient care. Transitions from hospital to outpatient care are associated with high rates of medication errors, miscommunication, readmission, and loss to follow up. Appointment delays are associated with higher patient no-show rates, resulting in patients lost to follow up and subsequent ED utilization and hospital readmission. We implemented a RAPH neurology clinic at our urban tertiary care center to reduce transition of care delays with the goal of ameliorating those risks.
Design/Methods:
RAPH Clinic comprised a weekly half day of four 1-hour appointments staffed by a neurohospitalist fellow with clinic nurse support. Appointments were assigned by direct communication between inpatient housestaff and the fellow, at which time the suspected diagnoses, actionable pending tests, and medication changes were reviewed. Clinical data, such as discharge diagnosis, reason for urgent follow up, changes in diagnosis and management at clinic follow up were collected. Time to RAPH Clinic and first alternative regular neurology clinic appointment were recorded for each patient.
Results:
In the first two months, RAPH Clinic fill rate was 78%. 20 patients were evaluated; no show rate was 9%. The most common diagnostic categories were headache (24%) and epilepsy (24%). 55% of patients had changes to their discharge diagnosis and 85% required changes in medication or clinical management. The average time between discharge and RAPH Clinic visit was 14.9 days, compared to an average 87.6 days to first available regular clinic appointment.
Conclusions:
Our single-center experience found that a dedicated neurology RAPH clinic reduced delays to outpatient follow-up and enabled clinically important management changes in a high proportion of cases. The impact on safety metrics, patient and provider satisfaction, and operational performance will become evident as we accrue further data.