Editor – We read the article ‘Hyperacute neurology at a regional neurosciences centre’ with interest.1 The experience of the St George's team in their first year of providing the service demonstrates the improvements in care that can be anticipated through the intensive involvement of neurology at the ‘front door’.
Our own experience also supports the approach (though we use the term ‘acute neurology service’). We hope this may also be of interest to units as it demonstrates that such systems can be both ‘scaled up’ and become embedded as a ‘routine’ method of care.
We have been running a 365 days-a-year, 7 days-a-week acute neurology service in Plymouth for almost 15 years. Last year we were proud to be finalists in the Health Service Journal awards for best Acute Services Redesign.
We found that this method of care reduced length of stay by 37% and the bed base by 46%. When we analysed the first 10 years of our service we found we had cared for approximately 20,000 patients. Our acute neurology admission avoidance clinics have been running for around 6 years and have cared for approximately 4,500 patients. They have mitigated the effects of the sustained rise of acute neurology referrals, with a sustained 30% reduction in admissions to the ward team and an increase in the zero length-of-stay rate from 25% to 40%.
We fully support the conclusions reached by the St George's team and agree that a proactive acute neurology model of care can have a transformative effect. Our experience of running an acute neurology service demonstrates these services remain both efficient and sustainable over a prolonged period of time.
References
- 1.Moodley KK, Jones V, Yogarajah M, et al. Hyperacute neurology at a regional neurosciences centre: a 1-year experience of an innovative service model. Clin Med 2019;19:119–26. [DOI] [PMC free article] [PubMed] [Google Scholar]