In February 2021, the neurology department at The Walton Centre implemented a game-changing way for patients to receive an initial neurological assessment. Born from the need to reduce pressures on the region’s A&E services during the COVID-19 pandemic, clinicians devised a criteria which would allow patients presenting with certain symptoms to be rapidly referred to the specialist neurosciences Trust.

Two and a half years in, and RANA (Rapid Access to Neurological Assessments) has seen nearly 700 patients, saving approximately the same number of bed days in 30 neighbouring Trusts.

Divisional Clinical Director for Neurology and Consultant Neurologist Dr Anita Krishnan said: “A significant proportion of acute inpatient referral requests from our partner hospitals can be common neurological disorders, ranging from new onset headaches and seizures to functional disorders and sensory disturbance.

“Before RANA, many of these patients with new neurological signs or symptoms, would often be admitted to the hospital they attended, and wait for a visiting neurologist, who would assess them, agree next steps and discharge them. Under RANA, patients who fit the pathway criteria are referred immediately to The Walton Centre.

“Once referred, they receive an appropriate assessment, diagnosis and potentially further care in the RANA clinic – from the most appropriate person, in the appropriate time frame, without getting stuck in the wider healthcare system unnecessarily. Patients can expect efficient diagnosis and management of their condition and subsequent treatment if required.”

In a recent audit of the pathway, 60% of patients seen were diagnosed on the day, 30% were discharged after their first visit with a care plan and 43% of patients were follow-up. A handful of patients were referred to neurosurgery for further management and seven were diagnosed with life-limiting neurological conditions. Patients are also referred to and assessed in a purpose-built clinical area dedicated to this innovative service.

Dr Krishnan continued: “Over the last two and a half years, we’ve been able to see a range of patients who may have otherwise waited in hospital beds before getting a neurological opinion. It’s been a real team effort from both clinical and non-clinical staff to ensure the system works well and I’m proud of what we have achieved so far. The feedback from the neighbouring Trusts has also been very positive.”

Divisional Director of Operations for Neurology Jennifer Duffy said: “We now have a high functioning, purpose-built space for RANA patients here at The Walton Centre. Our ambition is to build on this, maximise the number of patients that are supported via this pathway and deliver outstanding care to those patients who need it. 

“Feedback from patients so far has been really positive. We’re hearing that the speed of referrals is helping them to get answers quickly, and that they can benefit from the expert neurological service we provide.”