The Neurohospitalist
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The Neurohospitalist · Apr 2014
Introduction of a Pediatric Neurology Hospitalist Service With Continuous Electroencephalography Monitoring at a Children's Hospital.
Hospitalists, specializing in inpatient medicine, are increasingly being utilized in the hospital setting to improve efficiency, decrease costs and length of stay, and potentially improve outcomes. With these goals in mind and with the purpose of addressing the specific needs of patients on the inpatient pediatric neurology service, we established a pediatric neurohospitalist service in 2009. The primary purpose of this article is to describe the structure and the rationale for a pediatric neurohospitalist service with continuous electroencephalography at a pediatric teaching hospital and to discuss the categories of disease seen by the inpatient neurology service.
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Delirium is an acute change in awareness and attention and is common, morbid, and costly for patients and health care systems. While hyperactive delirium is easily identifiable, the hypoactive form is more common and carries a higher mortality. Hospital systems to address delirium should consist of 3 critical steps. ⋯ The key lies in addressing the underlying cause/causes of delirium, which often involve medical conditions or medications. With a sustained commitment, standardized efforts to identify and prevent delirium can mitigate the long-term morbidity associated with this acute change. In the face of changes in health care funding, delirium serves as an example of a syndrome where care coordination can improve short-term and long-term costs.
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The Neurohospitalist · Apr 2013
Paraneoplastic and other autoimmune disorders of the central nervous system.
As a result of the burgeoning growth of disease-specific neural autoantibody markers available for diagnostic patient evaluation, there has been increasing awareness of autoimmune central nervous system (CNS) disorders in hospital practice. Hospital-based neurologists have also taken great interest in these disorders since many occur in the setting of an occult systemic cancer which can be detected and treated at an early stage, and many affected patients are responsive to immunotherapy. Associated neurological disorders are typically subacute in onset, some are common or classic (eg, limbic encephalitis, cerebellar degeneration), but others have atypical or multifocal presentations. ⋯ For some patients, rapid treatment with immunotherapy may facilitate marked improvement, or full recovery; multiple sequential trials of one or more of steroids, intravenous immunoglobulin or plasma exchange, or combination therapy are often required. For patients with N-methyl-d-aspartate receptor antibody encephalitis, early treatment with immunosuppressants and weeks or months of supportive intensive care may additionally be required. One or more of clinical examination, electroencephalogram (including video telemetry), and imaging provide objective parameters to which posttreatment outcomes can be compared.
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The Neurohospitalist · Jan 2013
The use of neuroimaging studies and neurological consultation to evaluate dizzy patients in the emergency department.
Dizziness is a frequent reason for neuroimaging and neurological consultation, but little is known about the utility of either practice. We sought to characterize the patterns and yield of neuroimaging and neurological consultation for dizziness in the emergency department (ED). ⋯ In a tertiary care ED, neuroimaging and neurological consultation were frequently utilized to evaluate dizzy patients, and their diagnostic yield was substantial.
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The Neurohospitalist · Oct 2012
Neurohospitalists Improve Door-to-Needle Times for Patients With Ischemic Stroke Receiving Intravenous tPA.
It is unknown whether neurohospitalist evaluation improves door-to-needle times (DNT) in patients with acute ischemic stroke.The purpose of this study is to determine the impact of neurohospitalist evaluation on DNT for patients with ischemic stroke receiving intravenous tissue plasminogen activator (tPA) presenting within 4.5 hours of symptom onset. ⋯ Neurohospitialist evaluation is associated with faster DNT in patients with ischemic stroke. Neurohospitalist evaluation could be a part of a multidimensional initiative to improve the timeliness of tPA administration.