044 Analysis of urgent acute medicine and ward referrals to neurology at the district hospital


The aim of the study was to analyse the referrals for patients presenting with neurological emergency to the district hospital, as this aspect of the neurologist’s workload is often under-recognised, in comparison to attention dedicated to out-patient clinics.


We retrospectively reviewed acute medicine and ward referrals to Neurology service at the Hillingdon Hospital (July 2019-June 2020).


Total 1480 referrals were identified, with 50% of them from the Acute Medicine, 42% from the General Medicine, 8% from the other units. A 73.2% of referrals constitute delirium, falls, and other multi- factorial syndromes, presented as ill-defined and clinically challenging cases, 14.5% - acute headaches and neuroinflammatory disorders, 12.3% seizures/fits/syncopes. Regarding ward referrals, there was an average 5.4 days’ time lag between time of admission and neurological input, at the average 11.8 days of hospitalization. An early neurological consultation was likely to lead to more tailored diagnostic workup, improving outcome for the patient.


The amount of referrals reaffirms the importance of the neurologist’s role in the Emergency Care and the unmet need for acute neurology service, which is likely to increase with pressure on the district general hospitals to manage complex neurological cases locally given that the pandemic affects the safe transfer of patients to tertiary neurosciences centre for onward management.