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Diagnosis of MS: a comparison of three different clinical settings

National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK

E Keenan

National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK

E Record

Department of Clinical Governance, Dorville House, The Middlesex Hospital, Mortimer Street, London W1N 8AA, UK

A J Thompson

National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK, Institute of Neurology, Queen Square, London WC1N 3BG, UK, a.thompson{at}ion.ucl.ac.uk

In order to compare a newly established diagnostic clinic with two existing clinical settings in the management of the diagnostic phase of multiple sclerosis (MS), a retrospective audit was performed over a 12-month period comparing the length of time, adherence to recently published standards and price charged in diagnosing MS in three different clinical diagnostic settings operating within the same hospital: a specifically designed demyelinating disease diagnostic clinic (DDC), a general neurology clinic (GNC) and an inpatient investigation unit (IIU). A n audit tool was created to measure the standards advocated by the UK MS Society on management of the diagnostic phase of MS. The costing tool was the price charged to health authorities. A randomized retrospective case note and referral letter review method was used. The entry criterion was a confirmed diagnosis of MS documented in the medical notes following investigation during the period A pril 1999-A pril 2001. The time between referral and first appointment favoured the DDC with a mean time of 5.9 weeks, compared to 7.7 weeks for the G NC and 10.0 weeks for the IIU. The mean times between the first appointment and receipt of results were 4.7 weeks (DDC), 18.8 weeks (GNC) and 21.2 weeks (IIU). Prices ranged from £395-£790 (DDC), £95-£380 (GNC) and £1940-£2700 (IIU). This study suggests that the UK MS Society standards are achievable in most areas without excessive additional costs and provides evidence that the DDC offers a better service than other existing models.

Key Words: clinical audit • diagnosis • multiple sclerosis

Multiple Sclerosis, Vol. 9, No. 5, 431-439 (2003)
DOI: 10.1191/1352458503ms940oa


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