Abstract Details

Title Hospital Teleneurology Role Leads to Significant Wait Time Reduction for Follow Up Appointments and Increased Access to Subspecialists

Topic Practice, Policy, and Ethics

Presentation(s) P15 - Poster Session 15 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-003

Background Obtaining a prompt follow-up appointment with neurology after an ER visit in our rural catchment area is difficult. Conversely, up to 20% of clinic slots go unfilled due to cancellations. In this quality improvement initiative, we created a system that utilized ER telemedicine consultation/triaging to facilitate placing patients into cancellation slots in an effort to reduce time to be seen, reduce admissions, and improve slot utilization.

Objective To evaluate a new scheduling system designed to reduce time from initial evaluation to follow-up appointment, with a neurology subspecialist, for patients seen by a teleneurologist in the emergency room.

Design/Methods From October 2020 to July 2021 the ER teleneurology providers included a process of identifying patients who necessitated an urgent outpatient evaluation. Patients were handed off to nurse navigators who assigned appointment slots with the appropriate subspecialist. Follow-up data from this population was reviewed to determine the effectiveness.

Results Consulting teleneurologists identified 208 patients that merited urgent outpatient evaluation. One-hundred fifty patients (73%) kept their appointment with an average time to be seen of 12 days (department’s average time to be seen is 3-6 months, depending on subspecialty). The most common condition identified was stroke/transient ischemic attack, which constituted 32% of visits, with 90% being seen by vascular neurologists. Seizure was the next most common condition at 27%, with 85% being seen by epileptologists. Only 5 patients in this cohort required admission for their chief neurologic complaint, with likely many avoided. Of the 58 patients that did not attend their appointment, at least 50% reported resolution of their symptoms .

Conclusions Adding an outpatient triage role to teleneurologists seeing ER consults and assigning a nurse to assist with scheduling urgent appointments created a new avenue for access, reduced wait times for appointments, potentially avoided unnecessary admissions, and filled slots that would previously have remained unfilled.

Authors/Disclosures
Matthew Hart, MD (Matthew Hart) PRESENTER	Dr. Hart has nothing to disclose.
Sandeep Gill, MD (Aurathirty2)	Dr. Gill has nothing to disclose.
Sukhraj Gill, MD	Dr. Gill has nothing to disclose.
	No disclosure on file
Scott M. Friedenberg, MD, FAAN (Geisinger Medical Center)	Dr. Friedenberg has received research support from AMA. Dr. Friedenberg has received research support from Geisinger Medical Center.
Anthony Noto, MD (Geisinger Medical Center)	Dr. Noto has nothing to disclose.