Neurological patient care in emergency departments. A review of the current situation in Spain.

INTRODUCTION: We are currently seeing many changes in urgent neurological care, in the context of the progressive development of the specialty and of the increasing population and care demand. SOURCES: Medline and documentation obtained from the Spanish Society of Neurology (SEN) were employed as main data sources to review papers on the matter published in our country. We found articles describing neurological care in Emergency Departments (ED) of different Spanish hospitals, review articles, and others with neurological care organisational approaches. DEVELOPMENT: Stroke, headache and epilepsy were the most common disorders seen in ED. Up to 10-15% of medical emergencies were neurological. Their frequency increased with age and has been increasing over the last decade. The presence of a neurologist 24 hours a day, everyday, led to a significant reduction in hospital admissions and in length of stay, as well as other parameters of quality of care. Stroke has motivated many specific works that associate the presence of a neurologist in ED with an improvement in prognosis, quality of care and the overall cost of stroke. SEN has repeatedly expressed its concern about urgent neurological care provided to patients, and it promotes a greater generalization of on-call neurologists in hospitals in our country.
CONCLUSIONS: Urgent neurological disease is common, complex, and in many cases, potentially serious. The role of the neurologist in the ED is important for its optimum management. On-call neurologists, still absent in many Spanish hospitals, can improve both the quality of care and its efficiency.