Urgent neurology out-patient referrals from primary health care physicians

We retrospectively analysed patients seen in a rapid referral clinic toidentify those with abnormalities genuinely requiring urgent assessment,and to evaluate the impact of the clinic on routine services. Afteradvertising the availability of the service, 25% of telephone referralsfrom primary-care physicians led to identification of patients consideredsuitable for urgent evaluation. We assessed 350 patients over an 18-monthperiod. After neurological review, relevant abnormalities were identifiedin 73%, and 33% were considered to have warranted urgent assessment. Inaddition, 74% required radiological evaluation and 14% had aneurophysiological procedure; 19.4% were admitted on the same day, 13%underwent CSF analysis and 34% required some form of therapeuticintervention. In retrospect, patients with a clinical history of > 11days rarely warranted urgent referral. Visual failure and diplopia providedthe highest correlation with patients deemed to require urgent assessment,and syncope and headache the lowest. Despite the number of patientsreviewed, no effect was demonstrated on waiting times for standardout-patient review.