Objective:

 To improve delivery of neurology consultation services at an urban academic hospital.

Background:

The volume of neurological consultations has grown annually, at a rate outpacing attending staffing capabilities, resulting in new consultations generally being prioritized over subsequent evaluations. At our hospital, follow-up recommendations have predominantly been made remotely via chart review and provider discussions. We identified an opportunity to improve care delivery by increasing in-person follow-up visits.

Design/Methods:

Based on chart review of all patients seen by the neurology consult service over a 4-week period in FY24, we estimated that on average, there were 5 patients daily who were not seen but would have benefited from in-person assessment after recommended testing resulted or to trend the neurologic exam. To improve care continuity while mitigating increasing consult volume, we expanded the general neurology consult service from a one-attending to two-attending model. The first attending is a dedicated neurohospitalist present throughout the week (Monday-Friday), and the second is a predominantly outpatient subspecialist who is on service on the weekend, all day Monday, and half days the remainder of the week. Having both a neurohospitalist and an outpatient attending on the consult service enhances the trainee educational experience by providing exposure to multiple subspecialists.

Results:

In FY24, the general consult service saw an average of 33.3 new consults (6.7/day) and 8.9 follow-ups (1.8/day) during the week. In the first 12 weeks of FY25 after service expansion, the combined general consult services saw an average of 42.3 new consults (8.5/day) and 31.4 follow-ups (6.3/day) during the week. On weekends, when there remains a single attending, the consult team saw an average of 2 follow-ups/day.

Conclusions:

The addition of a second part-time consult attending has fulfilled a need for increased volume of neurological follow-ups and has improved continuity of care for patients and communication with primary teams.