Effectiveness of Neurology Consultations: Comparing Emergency and Inpatient Requests

Background: Neurological symptoms account for a significant portion of emergency department (ED) visits. Neurological evaluation may be needed in 8–15% of ED admissions. In this study, neurology consultation requests from emergency and other inpatient services are analyzed to determine the workload of the neurology consultation service. Methods: This was a retrospective, 13-week audit of 373 neurology consultations performed between December 1, 2019, and February 29, 2020. Both emergency and inpatient referrals were evaluated, and each case was categorized by urgency level. Results: The majority of ED consultations were classified as “Urgent” (n = 135 [61.09%]). Almost all consultations classified as “Very urgent” were requested from the ED (n = 19 [95%]). Consultations classified as “Elective” were least likely to be requested from the ED (n = 40 [18.1%]; P < 0.01). While the highest level of concordance between the neurologist and the requesting physician’s preliminary diagnoses was observed in the most Urgent cases (n = 149 [68.3%]), the highest level of inconsistency was observed in the Elective cases (n = 59 [46.8%]). Urgent or Very urgent cases were significantly more frequent in ED consultations (69.7%, 95% CI: 63.3–75.4) compared to non-ED consultations (36.2%, 95% CI: 28.9–44.1). Diagnostic concordance was highest in Urgent cases (68.3%, 95% CI: 61.9–74.1). Conclusion: A non-neurologist physician can recognize an Urgent and a Very urgent situation, but the workload of the neurologist increases in non-primary neurological or elective situations. The fact that no management changes were made in 29.6% of the patients indicates the extent of unnecessary workload and costs.