URGENT NEUROLOGY OUTPATIENT REFERRALS FROM PRIMARY HEALTH-CARE PHYSICIANS

We retrospectively analysed patients seen in a rapid referral clinic t o identify those with abnormalities genuinely requiring urgent assessm ent, and to evaluate the impact of the clinic on routine services. Aft er advertising the availability of the service, 25% of telephone refer rals from primary-care physicians led to identification of patients co nsidered suitable for urgent evaluation. We assessed 350 patients over an 18-month period. After neurological review, relevant abnormalities were identified in 73%, and 33% were considered to have warranted urg ent assessment. In addition, 74% required radiological evaluation and 14% had a neurophysiological procedure; 19.4% were admitted on the sam e day, 13% underwent CSF analysis and 34% required some form of therap eutic intervention. In retrospect, patients with a clinical history of >11 days rarely warranted urgent referral. Visual failure and diplopi a provided the highest correlation with patients deemed to require urg ent assessment, and syncope and headache the lowest. Despite the numbe r of patients reviewed, no effect was demonstrated on waiting times fo r standard out-patient review.