Alternativ til nevrologiske akuttinnleggelser

Abstract

Background Over the last two decades the annual number of patients being hospitalized at the Department of Neurology; Trondheim University Hospital has increased by 75%. Approximately 90% of these patients are admitted urgently. Previous studies have shown that 10-15% of acute admissions could have been handled at a lower priority level. Purpose To examine the potential of avoiding hospitalization by handling admissions alternatively, primarily as outpatients, and if this might provide an opportunity to reallocate treatment resources. Material and method Patients who were admitted acutely to the Department of Neurology, Trondheim University Hospital were consecutively asked to participate. After inclusion the doctor on call, the discharging doctor as well as senior staff of the department evaluated the appropriateness of the admissions. Information was also collected from the patient records and the hospital’s patient administrative systems. Results Out of the 189 included admissions, the rating doctors or teams found that 16.5 - 43.4 % could have been handled without hospitalization. However, full agreement that admissions were unnecessary was observed in only 5,3 % of the cases. There were no obvious commonalities between these admissions. Conclusions The poor agreement between evaluating doctors and teams reveals a lack of consensus criteria for emergency hospitalization for neurological symptoms or signs. A reduction of at least 5.3 % of the acute admissions does not allow for any ward reorganization, but points at a potential for increased activity at the outpatient acute clinic. With better criteria for investigation and treatment of common neurological problems there probably is a considerably increased potential for outpatient investigation and treatment of acute neurological cases.