Delivering acute neurology care via the Same Day Emergency Care (SDEC) model

Abstract

SDEC is the provision of same day care for emergency patients who would otherwise be admitted to hospital. Embedded within UCLH Emergency Department (ED), the SDEC cases are referred for consultant review. We aimed to determine whether a Neurology SDEC (N-SDEC) service would have a beneficial impact at UCLH.The service has run a weekday consultant neurologist-led service since May 2021. The service is supported by a nurse practitioner. Investigations are arranged via dedicated SDEC slots. The patient then has a nurse-led telephone follow-up. The service sees approximately 100 neurology referrals a month.The major impact of the service is reduced time to diagnosis and treatment and reduced onward referral. Only 5% of referrals to N-SDEC required onward General Neurology out-patient services. For the new diagnoses that require sub-specialist out-patients (9%), N-SDEC has improved the patient pathway (e.g. for neurovascular, multiple sclerosis, brain tumour, and neuro-vestibular presentations). We have also established new acute pathways (e.g. for status migrainosis and acute functional neurological disorders). Feedback on the new service from ED staff shows that the N-SDEC is also popular.Experience so far with the N-SDEC model indicates that it may provide an effective model for Acute Neurology delivery in the ED.