Overview of Hospital Neurology

Published on 14/05/2017 by admin

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Last modified 14/05/2017

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E. Lee Murray, MD, and
Monico Peter Baňez, MD, MBA, FACP, SFHM

OVERVIEW

Hospital neurology is a rapidly growing subspecialty. In addition to hospital-based general neurologists, there has also been an expansion of hospital-based specialty care services, including stroke centers, epilepsy centers, and neuro-critical care services.

There is a clear need for more neurologists of all types, but particularly hospital neurologists. Neurologic diagnoses make up between 10% and 20% of admissions to hospitals,1 and a disproportionate number of delayed discharges have primary neurologic diagnoses.2 Hospital neurology services can help to improve the quality and efficiency of care.

Where will the hospital neurologists come from? A diverse group is a product of diverse pathways. A few will do defined hospital neurology fellowships, some will have completed stroke or neuro-critical care fellowships, whereas others will be general neurologists.

In this book, we use the term hospital neurologist. An equivalent term is neurohospitalist. Other predominately hospital-based neurologists include stroke neurologists and neurointensivists.

MODELS OF A HOSPITAL NEUROLOGY SERVICE

The organization of a hospital neurology service depends greatly on the features of the practice, including institution size, patient volume, referral patterns, and community culture (see Table 1.1).

Table 1.1 Models of a hospital neurology practice

Practice type Features Advantages Disadvantages
Hospital neurologist

Neurologist who spends most or all practice time in hospital.

Can be admitting or purely consultative practice, especially in larger hospitals.

No conflict of divided time with clinic duties.

Usually shift-work.

Compensation usually better than most clinic work.

Reduced control over patient load.

More weekend and holiday work.

Reduced control over who is sharing care responsibilities.

Teleneurology Phone and/or Internet-based communication between a neurologist and provider at a remote location.

Hospital can be covered 24/7 even if it does not have sufficient on-call neurologists.

Transfers can be facilitated or obviated.

Acceptance by some providers and patients is incomplete.

Reimbursement is complex and dependent on facility, location, and service provided.

Mixed office and hospital Traditional office practice with hospital call.

Mix of inpatient and outpatient care is interesting for many neurologists.

Ease of scheduling of hospital follow-ups to the provider’s own clinic.

Pull between clinic and hospital(s) can stress the capabilities of the provider.
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