{
  "abstract": "Background Acute neurological presentations are common in emergency settings. These are managed with a high rate of misdiagnosis in about one-third of cases. This is the first description of a consultant-led model within an existing same day emergency care service.Methods As part of service evaluations, we prospectively collected data from 931 acute neurological presentations, over the first year since establishing the neurology same day emergency care (NeuroSDEC) embedded within the emergency department (ED) at University College London Hospital. The service was evaluated in terms of diagnostic accuracy, cost-saving and efficiency.Results 60.8% were female, mostly between 25 years and 40 years old. Most referrals were from ED, with the most common presenting symptom of headaches (343 cases, 36.8%).NeuroSDEC reduced lack of diagnosis in over 27% of cases, prevented admissions in over one-third of cases seen, saw same-day cases on average within 1 hour, reduced intended outpatient neurology referrals from 36.4% to 4.8%, cut stroke and transient ischaemic attack clinic referrals in half, completed the care of more than a third of cases (36.1%) exclusively in NeuroSDEC, aborted unnecessary acute brain imaging in 9.7% and cut intended lumbar punctures by 40% (49 reduced to 29).Conclusion Acute neurology presentations challenge acute physicians in distinguishing benign from serious neurological conditions in real time. Our NeuroSDEC model provides a successful example of a transformative healthcare model, safely reducing unnecessary investigations, outpatient referrals, admissions and misdiagnosis rates. A conservative estimate for potential cost savings was £660 000 in admission prevention alone, more than the excess staff cost of £363 000.",
  "authors": [
    {
      "affiliations": [
        "Neurology Same Day Emergency Care (NeuroSDEC), University College London Hospitals NHS Foundation Trust, London, England, UK",
        "Hillingdon Hospitals NHS Foundation Trust, Uxbridge, England, UK",
        "National Hospital for Neurology and Neurosurgery, London, England, UK"
      ],
      "name": "Ali Alim-Marvasti"
    },
    {
      "affiliations": [
        "Neurology Same Day Emergency Care (NeuroSDEC), University College London Hospitals NHS Foundation Trust, London, England, UK",
        "National Hospital for Neurology and Neurosurgery, London, England, UK"
      ],
      "name": "Michelle Balaratnam"
    },
    {
      "affiliations": [
        "Neurology Same Day Emergency Care (NeuroSDEC), University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Benjamin Sacks"
    },
    {
      "affiliations": [
        "Neurology Same Day Emergency Care (NeuroSDEC), University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "William Bierrum"
    },
    {
      "affiliations": [
        "Neurology Same Day Emergency Care (NeuroSDEC), University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Maria Francisca Rocha"
    },
    {
      "affiliations": [
        "University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Isaiah See"
    },
    {
      "affiliations": [
        "Neurology Same Day Emergency Care (NeuroSDEC), University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Roberto Macarimban"
    },
    {
      "affiliations": [
        "Neurology Same Day Emergency Care (NeuroSDEC), University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Charlie Lane"
    },
    {
      "affiliations": [
        "Neuro-otology, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Nehzat Koohi"
    },
    {
      "affiliations": [
        "Ambulatory Care and Medical SDEC, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Anne Schlattl"
    },
    {
      "affiliations": [
        "Ambulatory Care and Medical SDEC, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Christine Gregson"
    },
    {
      "affiliations": [
        "Ambulatory Care and Medical SDEC, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Ben Killingley"
    },
    {
      "affiliations": [
        "Emergency Department, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Alun Marc Henry"
    },
    {
      "affiliations": [
        "Emergency Department, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Timothy Baruah"
    },
    {
      "affiliations": [
        "Neurology, University College London Hospitals NHS Foundation Trust, London, England, UK",
        "MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, England, UK"
      ],
      "name": "Chris Turner"
    },
    {
      "affiliations": [
        "Neuro-otology, University College London Hospitals NHS Foundation Trust, London, England, UK"
      ],
      "name": "Diego Kaski"
    },
    {
      "affiliations": [
        "Neurology Same Day Emergency Care (NeuroSDEC), University College London Hospitals NHS Foundation Trust, London, England, UK",
        "Stroke Service, National Hospital for Neurology and Neurosurgery, London, England, UK"
      ],
      "name": "Arvind Chandratheva"
    },
    {
      "affiliations": [
        "University College London Hospitals NHS Foundation Trust, London, England, UK",
        "Stroke Service, National Hospital for Neurology and Neurosurgery, London, England, UK"
      ],
      "name": "Robert Simister"
    },
    {
      "affiliations": [
        "Neurology Same Day Emergency Care (NeuroSDEC), University College London Hospitals NHS Foundation Trust, London, England, UK",
        "National Hospital for Neurology and Neurosurgery, London, England, UK",
        "Stroke Service, National Hospital for Neurology and Neurosurgery, London, England, UK"
      ],
      "name": "Salman Haider"
    }
  ],
  "title": "Prospective Evaluation of the Neurology Same Day Emergency Care (NeuroSDEC) Model in Secondary Care: data from 931 patients over the first 12 months",
  "uid": "4e06aaae-438d-509b-b3a6-81c11195c619"
}