To construct a grounded theory describing barriers to effective use of the neurology consult service in the pediatric emergency department and explore interventions to address these barriers.

Based on preliminary survey data from our institution, there is room for improvement in effective use of an already highly utilized neurology consult service. Specific areas include educational barriers in the care of children with neurological diseases. More detailed investigation is required to propose a theory as to the exact nature of these knowledge gaps and suggest possible interventions.

We interviewed providers from neurology and emergency medicine, including residents, fellows, NPs/PAs, and attending physicians. The interviews were semi-structured, with iterative inductive qualitative analysis as emergent themes informed future interviews. Interviews continued until reaching saturation.

Interview questions focused on common reasons for requesting consults, areas for educational interventions, and ideas for implementation.

We interviewed 13 providers (5 neurology providers, 8 emergency room providers). Two themes emerged. First, there is wide variation in education around the neurological exam. Both groups expressed interest in teaching on “red flag” neurological signs, specifically those with high inter-observer reliability. Second, many emergency providers feel uncomfortable independently determining initial workup of common neurological complaints, such as new-onset seizure, headache, and weakness. Much of this discomfort stems from a lack of confidence in their initial assessment of the patient. This further supports an educational program emphasizing the neurological exam.

Providers in the emergency room described a need for improved neurological examination skills to support more efficient use of neurology consult services. The next step is designing an educational intervention to improve emergency providers’ skills in the initial assessment of a child with a neurological complaint.