title: Referrals, Wait Times and Diagnoses at an Urgent Neurology Clinic over 10 Years.
abstract: BACKGROUND
  An urgent neurology assessment clinic was created at our institution to improve access to prompt neurological assessment, and has been in operation for over a decade. We assessed its timeliness and impact.
  
  
  METHODS
  The clinic database was examined retrospectively for trends in the volume and waiting time to assessments, neurologic diagnoses, and whether neurologic assessment changed patients' diagnoses. Before and after implementation, the frequency of emergency department neurology assessments and hospital admissions for neurological investigation were compared.
  
  
  RESULTS
  In the first decade, 25145 referrals were received; 12460 patients were accepted and assessed within an average of 3.8 working days. The most common problems seen included headache and seizure (20.2% each). Overall, 44.6% of assessments resulted in a change to the referring diagnosis; this proportion varied by the type of problem seen (from 10.5% for seizures to 92.5% for psychiatric disturbances). From the pre- to post-opening periods, there were fewer emergency room neurological assessments (35.7% reduction) and fewer hospital admissions for neurological investigation (4.4/week to 2.2/week, 50% reduction).
  
  
  CONCLUSIONS
  The urgent neurology clinic model at our institution has provided excellent service, including wait times of a few days, to a catchment of over two million Canadians for over a decade; clinic assessments have affected diagnoses and patient care.
authors.forename: D J
authors.initials: DJ
authors.lastname: Wile
authors.forename: J
authors.initials: J
authors.lastname: Warner
authors.forename: W
authors.initials: W
authors.lastname: Murphy
authors.forename: A L
authors.initials: AL
authors.lastname: Lafontaine
authors.forename: A
authors.initials: A
authors.lastname: Hanson
authors.forename: S
authors.initials: S
authors.lastname: Furtado
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D002170:Canada; D015331:Cohort Studies; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005157:Facial Pain / Q000175:diagnosis; D058006:General Practice; D006261:Headache / Q000175:diagnosis; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis*; D009460:Neurologic Examination; D009462:Neurology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis; D013997:Time Factors