Hospital-based neurologic care

James G Greene MD PhD (Dr. Greene of Emory University School of Medicine has no relevant financial relationships to disclose.)
Originally released September 6, 2015; last updated September 6, 2017; expires September 6, 2020

The evolution of the United States healthcare system has posed numerous challenges to neurology practices around the country that particularly impact the hospital setting. Traditional inpatient models based on limited coverage provided by predominantly outpatient-based providers have become nearly untenable in a clinical and regulatory environment increasingly focused on short hospital stays, cost-effectiveness, electronic documentation, and quality metrics. In many instances, neurologists recognize both a widening knowledge gap and severely limited availability that requires medicine hospitalists to take the lead in managing complicated inpatients without expert guidance. This article addresses the role of the burgeoning subspecialty of hospital neurology in which neurohospitalists take primary responsibility for providing neurologic expertise in the hospital. This is a critical issue many private practices and academic departments are facing as neurohospitalist programs proliferate across the country (Likosky and Amin 2005; Freeman et al 2008; Josephson et al 2008; Likosky 2009; Barrett and Freeman 2010; Likosky et al 2010; Freeman and Josephson 2011; Likosky and Aragon 2015).

The neurohospitalist model has 2 main theoretical advantages over more traditional inpatient care models: (1) expertise in managing acute neurologic disorders and navigating an increasingly complex healthcare system, and (2) availability to patients, staff, and trainees in the absence of extensive commitments in outpatient or laboratory settings. Neurohospitalists represent a group of neurologists ideally situated to effectively and efficiently care for hospitalized patients, lead interdisciplinary care teams, work with hospital administration to improve the value of neurologic care, and train housestaff and medical students. Multiple factors internal and external to clinical neurology have provided an opportunity that could be truly transformative – not only changing the way hospital-based neurologic care is provided, but allowing neurologists to expand and enrich outpatient clinics, research laboratories, and neurologic education.

Overview

Escalating economic pressures, a complex regulatory environment, and an ever-expanding scientific knowledge base are threatening to make traditional models for hospital-based neurologic care untenable. Similar to medical hospitalists nearly 20 years ago, neurohospitalists are an emerging group of inpatient subspecialists that have rapidly evolved as a way to bridge the widening gap between increasingly focused outpatient neurologists and the demands of inpatient care for acute neurologic disease. In this article, the author reviews advantages and disadvantages of novel models for hospital-based neurologic care and their potential impact on the future practice of neurology.

Key points

 

• The evolution of the U.S. healthcare system has posed numerous challenges to neurology practices around the country that particularly impact hospitalized patients in a clinical and regulatory environment increasingly focused on short hospital stays, cost-effectiveness, electronic documentation, and quality metrics.

 

• Neurohospitalists represent a burgeoning subspecialty group of neurologists ideally situated to effectively and efficiently care for hospitalized patients, lead interdisciplinary care teams, work with hospital administration to improve the value of neurologic care, and train housestaff and medical students.

 

• A sea of change is underway in the provision of neurologic care, which will have a substantial impact on current and future neurologists.

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