A patient hospitalized for a heart attack may suddenly have a stroke. A patient hospitalized with a metastatic tumor may suddenly have a seizure. Providers within Duke’s new division of Hospital Neurology specialize in helping patients with complex, overlapping conditions across all three Duke hospitals.
In this Q&A, division chief Matthew W. Luedke, MD, discusses this expanded approach to patient care and how neurohospitalists can help fill gaps in inpatient and outpatient settings.
Q: How would you describe the new division and the benefits it brings to patient care?
Luedke: We are a multispecialty team of neurologists who provide inpatient neurologic care across the three Duke University Health System hospitals—regardless of service line, regardless of where patients are receiving treatment within the hospital settings. Most of our department’s other divisions tend to be subspecialty-focused and located in a single space; for example, our neurocritical care faculty provides comprehensive care but exists within our neuro ICU. Some neurology patients may not be able to come to dedicated units, often because they’re also dealing with complex non-neurological issues.
This is where our neurohospitalists shine: treating patients with liver failure in the medical ICU as they are having seizures; helping patients in the surgical ICU or cardiothoracic ICU as they are having a stroke; treating patients in an orthopaedics unit who are having entrapment neuropathy; or treating patients who need acute epilepsy care in the ED. There’s a whole panoply of neurological disease that happens frequently in the setting of other disease that needs to be managed, and that’s what we do.
Q: How will Hospital Neurology impact Duke’s other clinical divisions?
Luedke: I believe the new division will help our colleagues provide better patient care and improve their quality of life as providers. Neurohospitalists sometimes see things that aren’t visible to outpatient neurologists; for example, we may observe that patients with a certain disease have frequent readmissions because they don’t understand what to expect in the outpatient setting. Seeing enough patients like this allows us to support our outpatient colleagues in managing complex cases. And, when clinic neurologists have to make time to see a hospitalized patient, they may not be able to manage their growing number of outpatients effectively, so neurohospitalists can alleviate some of that pressure while providing better access for patients.
Q: Do neurohospitalists need specific board certification or additional training?
Luedke: Neurohospitalism is a multifaceted model of health care, with physicians providing acute inpatient care to patients with neurologic disease. It’s not defined by a specific set of subspecialty training and there’s currently no board-specific certification dedicated to it, so we all bring our subspecialty expertise to patient care and work as a team. For example, I identify both as a neurohospitalist and an epilepsy specialist. One of our other team members identifies as a critical care physician, a neurointensivist, and a neurohospitalist; another identifies as a stroke physician and a neurohospitalist. The field of acute care neurology is complicated enough with advances in stroke care and evolving paradigms in neurointensivism and pain management, so it’s very helpful to be able to take advantage of each other’s expertise in an intradisciplinary way and ensure the very best coordinated care for our patients.