Outpatient neurology diagnostic coding: a proposed scheme for standardised implementation.

Clinical coding uses a classification system to assign standard codes to clinical terms and so facilitates good clinical practice through audit, service design and research. However, despite clinical coding being mandatory for inpatient activity, this is often not so for outpatient services, where most neurological care is delivered. Recent reports by the UK National Neurosciences Advisory Group and NHS England's 'Getting It Right First Time' initiative recommend implementing outpatient coding. The UK currently has no standardised system for outpatient neurology diagnostic coding. However, most new attendances at general neurology clinics appear to be classifiable with a limited number of diagnostic terms. We present the rationale for diagnostic coding and its benefits, and the need for clinical engagement to develop a system that is pragmatic, quick and easy to use. We outline a scheme developed in the UK that could be used elsewhere.

Croydon neurology: assessing the impact of the introduction of patient initiated follow-up

NHS England identified Patient Initiated Follow Up (PIFU) as part of NHS COVID-19 recovery, in line with the personalised-care agenda. We aimed to assess how the introduction of PIFU for neurology patients at Croydon University Hospital (CUH) has impacted patient outcomes, capacity and non-elective admissions.Data were extracted from electronic records on all patients booked into a CUH neurology PIFU appoint- ment from 1st June to 29th October 2021. Data were collected on the number of admissions or outpatient attendances for 5 years pre-PIFU appointment and compared with 0-6 months post-PIFU.355 patients had a PIFU appointment at CUH neurology between 1st June and 29th October 2021. The most common neurological conditions prompting a PIFU appointment were epilepsy (40%), multiple sclerosis (22%) and Parkinson’s disease (12%). The average number of outpatient appointments reduced from 11.0 pre-PIFU to 1.5 post-PIFU. The average number of ED attendances reduced from 3.1 pre-PIFU to 0.4 post-PIFU.Although there are significant limitations in this study (inadequate time since appointment, the pandemic), we remain keen on PIFU and had been running an advice line service before it was labelled as PIFU. Further follow-up data and patient satisfaction data is needed.

Post discharge telephone calls from neurology specialist nurses can reduce re-admission rates: a re-audit

We carried out audits of all in-patients referred for consultant neurology opinions in a single district general hospital over 2-month periods in 2018 and after relevant adjustments in 2020.In 2018, of 235 patients seen, the overall 30-day re-admission rate was 18.7% (44 patients). Of the 235 patients, the consultant requested post discharge follow-up on 76 (32.3%) but only 42 were contacted (55%) of which 24 (57%) were phoned within 30 days. The re-admission rate was reduced by only 0.5% in those successfully contacted.In 2020, of 252 patients seen, the 30-day re-admission rate was 18.7% (47 patients). Follow up was requested for 52.8% (133 patients). We improved our successful telephone rate to 77% of which 49 (47.6%) were contacted in under 30 days. Re-admission rate for those contacted was reduced to 16.5% compared to 21% amongst those not contacted. The majority of re-admissions (55%) were for non-neurological diagnoses. Patients with multiple co-morbidities were 46% more likely to be re-admitted.NICE guidelines recommend a post discharge telephone follow-up. Our results suggest trying to achieve maximum early contact is likely to reduce re-admission rates.pahalavi@hotmail.co.uk