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To the emergency room and back again: circular healthcare pathways for acute functional neurological disorders


Williams, S and Southall, C and Haley, S and Dhafari, TB and Kemp, S and Relton, SD and Alty, JE and Johnson, O and Graham, CD and Maguire, M, To the emergency room and back again: circular healthcare pathways for acute functional neurological disorders, Journal of the Neurological Sciences, 437 Article 120251. ISSN 0022-510X (2022) [Refereed Article]


Copyright Statement

2022 The Authors. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)

DOI: doi:10.1016/j.jns.2022.120251


Background and objectives

Studies of Functional Neurological Disorders (FND) are usually outpatient-based. To inform service development, we aimed to describe patient pathways through healthcare events, and factors affecting risk of emergency department (ED) reattendance, for people presenting acutely with FND.


Acute neurology/stroke teams at a UK city hospital were contacted regularly over 8 months to log FND referrals. Electronic documentation was then reviewed for hospital healthcare events over the preceding 8 years. Patient pathways through healthcare events over time were mapped, and mixed effects logistic regression was performed for risk of ED reattendance within 1 year.


In 8 months, 212 patients presented acutely with an initial referral suggesting FND. 20% had subsequent alternative diagnoses, but 162 patients were classified from documentation review as possible (17%), probable (28%) or definite (55%) FND. In the preceding 8 years, these 162 patients had 563 ED attendances and 1693 inpatient nights with functional symptoms, but only 26% were referred for psychological therapy, only 66% had a documented diagnosis, and care pathways looped around ED. Three better practice pathway steps were each associated with lower risk of subsequent ED reattendance: documented FND diagnosis (OR = 0.32, p = 0.004), referral to clinical psychology (OR = 0.35, p = 0.04) and outpatient neurology follow-up (OR = 0.25, p < 0.001).


People that present acutely to a UK city hospital with FND tend to follow looping pathways through hospital healthcare events, centred around ED, with low rates of documented diagnosis and referral for psychological therapy. When better practice occurs, it is associated with lower risk of ED reattendance.

Item Details

Item Type:Refereed Article
Keywords:functional neurological disorders, emergency medicine, process mining, healthcare pathways, acute neurology, diagnosis, psychology, neurology
Research Division:Biomedical and Clinical Sciences
Research Group:Neurosciences
Research Field:Neurology and neuromuscular diseases
Objective Division:Health
Objective Group:Clinical health
Objective Field:Diagnosis of human diseases and conditions
UTAS Author:Alty, JE (Associate Professor Jane Alty)
ID Code:149797
Year Published:2022
Web of Science® Times Cited:1
Deposited By:Wicking Dementia Research and Education Centre
Deposited On:2022-04-14
Last Modified:2022-11-08
Downloads:6 View Download Statistics

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