Objective:

To report results eighteen months after implementation of the Complex Case Conference (CCC), a monthly dedicated forum for inter-specialty clinical case discussion. 

Background:

The field of neurology is becoming increasingly subspecialized as the knowledge needed to care for neurology patients expands rapidly. Neurologists are thus increasingly encountering challenging, undifferentiated cases which may not fit clearly within a single subspecialty. Few formalized opportunities exist for neurologists to present complex cases to peers with differing expertise, especially in departments spread across multiple sites. 

Design/Methods:

Informed by a survey-based needs assessment, [1] we initiated CCC. CCC was held monthly for 60 minutes, during protected departmental time for Grand Rounds. The forum was moderated and consisted of 30 minutes dedicated to a case selected in advance, and 30 minutes dedicated to serve as an open forum for active cases. Pre- and post-implementation surveys were administered to residents and faculty to assess the impact of this initiative.

Results:

Twelve neurology residents and attendings completed the pre-implementation survey;  22 residents and attendings completed the follow-up survey. A significantly higher proportion of respondents felt they had a good mechanism to discuss challenging cases within their subspecialty (p=0.002) and with other subspecialties (p=0.036) after implementation. There was a significant increase in knowledge of what resources exist across the institution (e.g. specialty lab tests and imaging studies) (p=0.009). There was a non-significant increase in intra-departmental referrals and recognition of cases where multispecialty input would be beneficial.

Conclusions:

After 18 months of CCC, respondents noted an improvement in intra- and cross-specialty clinical collaboration on complex clinical cases. There was an increase in institutional knowledge pertinent to clinical care. CCC offers a feasible strategy for enhancing care for patients who may benefit from multispecialty expertise. CCC has become a valuable attending-driven forum for supporting complex patient care while enhancing clinician growth, institutional knowledge, and collaboration.