Characterization of potentially avoidable neurological emergency department visits at a large urban public hospital

Abstract

This study characterized potentially avoidable neurological emergency department (ED) visits at a large urban public hospital. This was a retrospective review of Parkland Health (Dallas, TX) data from May 15, 2021, to July 15, 2021. The study population included encounters discharged home from the ED with any of the following: a primary neurological ED diagnosis, a neurological consultation in the ED, or a neurology clinic referral placed during the ED encounter. Neurovascular, strokelike, acute trauma, and nonneurological cases were excluded. The primary outcome was the number of ED visits by diagnosis category. A total of 965 ED discharge encounters met study criteria as potentially avoidable neurological ED visits, far higher than total neurology-related admissions over the same 2-month period. Headache (66%) and seizure/epilepsy (18%) syndromes were the most common. Thirty-five percent of all cases had neurology involvement in either the ED or the outpatient setting. This was lowest for headache (19%). The revisit rate within 3 months of the index ED visit was 29%, and it was highest for seizures/epilepsy (48%). Potentially avoidable nonvascular neurological ED visits occur frequently, especially for headache and seizure disorders. This study highlights the need for quality improvement and delivery innovation initiatives to optimize the site of care for patients with chronic neurological conditions.

Keywords:

• Emergency department utilization
• general neurology
• headache disorders
• quality
• seizure

Acknowledgments

The authors acknowledge the support and cooperation received from Bhavya Kadiyala (Parkland Office of Research and Administration, Dallas, TX) for assistance with acquisition of data. The authors thank Dalbir Bahga, MD, and A. J. Kirk, MD, for conceptual guidance regarding ED use at Parkland Health. The above-mentioned contributors received no compensation for their work other than their usual salary. They have no conflicts of interest relevant to this article.

Disclosure statement/Funding

The authors reported no external funding or potential conflicts of interest.