Provision of 24 hour acute neurology care by neurologists: manpower requirements in the UK

C Carroll, J Zajicek

Research output: Contribution to journalArticlepeer-review

30 Citations (Scopus)

Abstract

OBJECTIVES: The ABN has published standards of care for patients with acute neurological disease. Derriford Hospital provides a 24 hour neurology intake service to a population of 500,000 with the equivalent of four consultants, three specialist registrars (SpRs), and four senior house officers (SHOs) with a 37 bed ward. The authors undertook a prospective study of all neurology admissions to enable calculation of manpower necessary to meet the ABN guidelines.

METHODS: All admissions to the neurology department were analysed prospectively for a three month period (March to May 2002).

RESULTS: There were 629 admissions (equating to 2500 per year); data were collected for 93%. 78% of admissions were emergency, 16% elective. The mean number of neurology inpatients at any time was 76, with three (4%) being elective. The main diagnostic categories were stroke (29%), headache syndrome (13%), and epilepsy or seizures (12%). With regard to emergency admissions, 94% were seen by a neurology SHO within 6 hours and 81% by an SpR or consultant within 24 hours. Twenty five percent of emergency admissions were not seen by a consultant. 55% of patients were cared for on non-neurological wards for their entire admission. Median length of stay for stroke patients was 9.5 days, compared with 4 days for other patients. 37% of patients received a neurology follow up appointment. Currently each SpR spends 18 hours per week involved in the care of acute neurology admissions.

CONCLUSION: Meeting the ABN guidelines will require an increase in total neurology bed provision to at least 15 per 100,000 population, with the equivalent of 3 consultant sessions (11 hours/week). Meeting the European Working Time Directive will require a minimum of 8-10 SpRs working a full shift system, which will have a significant impact on training and other aspects of service delivery.

Original languageEnglish
Pages (from-to)406-9
Number of pages4
JournalJournal of Neurology, Neurosurgery, and Psychiatry
Volume75
Issue number3
Publication statusPublished - Mar 2004

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Emergency Service, Hospital
  • Epilepsy
  • Female
  • Great Britain
  • Headache
  • Hospital Bed Capacity
  • Hospitals, Community
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Nervous System Diseases
  • Neurology
  • Patient Admission
  • Practice Guidelines as Topic
  • Prospective Studies
  • Referral and Consultation
  • Stroke

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