Objective:

To improve access to outpatient neurology by reducing wait-times for patients requiring urgent neurological evaluation

Background:

There is currently a shortage of neurologists providing outpatient care, contributing to long wait-times. Stanford Neurology has an average wait-time of 86 days between the date of referral from the emergency department (ED) and the date of their outpatient appointment. Delays in care can negatively affect patient outcomes and cause undue psychological stress on patients waiting for their neurological evaluation. 

Design/Methods:

A novel clinic model was established to address the long wait-times by prioritizing new patient intake to maintain capacity to continuously accept new referrals. Return slots were strictly limited to one-time follow-up of investigations ordered at the first appointment or for reassessment after initiation of first-line management. Most patients follow up with their primary care provider based on neurology’s recommendations, and patients who require further neurological expertise are transferred to the relevant subspecialty clinic for long-term management.  Average wait-times were collected in the 6 months before and after this clinic was launched. The goal was to see patients within 14 days based on national benchmarks on ED referrals. 

Results:

In the 6 months after the clinic was established, the average wait-time was reduced from 86 days to 23, representing a 73% reduction (p<0.001). The 14-day target was not met due to several factors including patient preference for a later appointment date, being unable to reach the patient in a timely manner to schedule the appointment and limitations in provider schedule availability. 

Conclusions:

The pilot project was successful in dramatically reducing wait-times for ED referrals to outpatient neurology by 73%. These results suggest that this novel clinic model can likely be replicated at other healthcare institutions and could have a significant impact on neurology wait-times beyond Stanford Neurology.