Hyperacute neurology at a regional neurosciences centre: a 1-year experience of an innovative service model.
Kuven K Moodley, Valerie Jones, Mahinda Yogarajah, Bhavini Patel, Umesh Vivekananda, Pablo Garcia-Reitboeck, Kiran Samra, Gillian Cluckie, Oliver Foster, Anthony C Pereira, Niranjanan Nirmalananthan
Author Information
Kuven K Moodley: St George's University Hospitals NHS Foundation Trust, London, UK kuven.moodley@nhs.net.
Valerie Jones: St George's University Hospitals NHS Foundation Trust, London, UK.
Mahinda Yogarajah: St George's University Hospitals NHS Foundation Trust, London, UK.
Bhavini Patel: St George's University Hospitals NHS Foundation Trust, London, UK.
Umesh Vivekananda: St George's University Hospitals NHS Foundation Trust, London, UK.
Pablo Garcia-Reitboeck: St George's University Hospitals NHS Foundation Trust, London, UK.
Kiran Samra: St George's University Hospitals NHS Foundation Trust, London, UK.
Gillian Cluckie: St George's University Hospitals NHS Foundation Trust, London, UK.
Oliver Foster: St George's University Hospitals NHS Foundation Trust, London, UK.
Anthony C Pereira: St George's University Hospitals NHS Foundation Trust, London, UK.
Niranjanan Nirmalananthan: St George's University Hospitals NHS Foundation Trust, London, UK.
St George's Hospital hyperacute neurology service (HANS) is a comprehensive, consultant-delivered service set in a teaching hospital regional neuroscience centre. The service addresses deficiencies in acute neurological care previously highlighted by the Royal College of Physicians and the Association of British Neurologists. HANS adopts a disease-agnostic approach to acute neurology, prioritising the emergency department (ED) management of both stroke and stroke mimics alike alongside proactive daily support to the acute medical unit and acute medical take. Rapid access clinics provide a means to assess ambulatory patients, providing an outlet to reduce the burden of referral from primary care to acute medicine. This paper reports the results from the first year of the service. Admission was avoided in 25% of the cases reviewed in the ED. Compared to historic data, there was a significant improvement in the length of stay for non-stroke disorders while the occupancy of stroke beds by non-stroke cases reduced by 50%. The configuration of this service is replicable in other neuroscience centres and provides a framework to reduce the barriers facing patients who present with acute neurological symptoms.
