Abstract Details

Title Characterization of General Neurology Emergency Department Discharge Consultations: A Pilot Study into Potentially Avoidable Neurological ED Visits

Topic Practice, Policy, and Ethics

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

Poster/Presentation
Number 1-005

Background ED crowding/overuse affects the value of care in various settings, particularly centers serving historically underserved groups. Research within neurology is limited, often focusing on a specific condition. The separation of our inpatient neurology service lines into stroke versus general allows for characterization of potentially avoidable ED visits seen by the latter.

Objective

To characterize Emergency Department (ED) visits where the patient was discharged home after a general neurology consultation.

Design/Methods Cases came from Parkland Hospital, a large public-academic medical center serving Dallas County. Three separate two-week samples in 2020 of patients discharged home from the ED after a general neurology consultation were analyzed. Timeframes were based on author’s attending service times. Volumes were compared to all ED-discharge home encounters with a neurological primary diagnosis, excluding neurovascular cases.

Results There were 108 encounters of patients discharged home from the ED after a general neurology consultation, 38% of unique patient encounters seen by this inpatient service. The most common diagnosis group was seizure (36%), followed by headache (18%). At least 40% of the encounters were avoidable, being either non-emergent or emergent but avoidable. Most patients had financial coverage. Revisit rate within a month was 22-36%. The two-week September 2020 sample had the most cases (46). During that same timeframe, 187 total nonvascular neurological ED discharge home encounters took place, mostly headache (136).

Conclusions Within an urban public-academic hospital, there is a high number of potentially avoidable (nonvascular) neurological ED visits. Most such visits are headache-related and do not involve a neurologist. Seizure is the most common diagnosis type requiring neurologist assistance. This study supports prior research showing that having financial coverage does not automatically lead to less ED use. Further study is needed to determine the various drivers of ED use, particularly social determinants of health in a large urban system.

Authors/Disclosures
Anik Amin, MD (UT Southwestern Medical Center) PRESENTER	Dr. Amin has nothing to disclose.