In February 2011, the inaugural meeting of the Neurohospitalist Society signified the rise of a subspecialty that is filling a need for tailored, time-sensitive treatment of patients with neurological disorders or those who are at risk for one. "We've shown having experience and expertise available 24/7 can dramatically improve these patients' care,” says UCSF neurohospitalist Andy Josephson, M.D., co-founder of the Neurohospitalist Society and a pioneer in the field.

New Opportunities

"In the last decade, more effective neurological treatments have emerged, but speed matters," Josephson says. "When an expert is on site, anyone with a neurologic problem — whether they arrive with a primary neurologic diagnosis or another reason — can be seen quickly by a specialist."

Availability leads to experience, a second, critical advantage of a neurohospitalist program. Vanja Douglas, M.D., one of three fellowship-trained neurohospitalists on staff at UCSF Medical Center along with Josephson and Brian Scott, M.D., says, "We see so many cases, the most common and the strangest."

Add a deep understanding of inpatient systems and UCSF neurohospitalists have been able to:

• Improve compliance with deep vein thrombosis prophylaxis
• Achieve rapid and accurate diagnosis of previously unknown neurological conditions
• Better prevent or more rapidly treat delirium by working with nursing and rehab staff
• Develop predictive rules for which patients in the ER will likely develop delirium

The Gamut of Neurological Challenges

Neurohospitalists at UCSF treat an unusual volume of patients with a range of conditions that include:

• The acutely confused patient with a urinary tract infection. "These patients get a neuro consult, with access to appropriate testing and monitoring," Josephson says. In a current clinical study, where Josephson's team hypothesizes that clinically silent seizures are the cause of delirium in about 10 percent of these patients, continuous electroencephalogram (EEG) technology allows for monitoring, when needed, in any bed of the hospital.
• The postsurgery brain tumor patient with frequent seizures, despite being on normal doses of anticonvulsants. Continuous EEG enables neurohospitalists to quantify the seizures and titrate medications appropriately. A close relationship with the neurosurgical group allows for better care in the perioperative period.


• The patient who remains comatose after cardiac arrest. Douglas says, "Our neurology team evaluates these patients to determine whether they’re eligible for therapeutic hypothermia, an intervention that can improve outcomes." Neurohospitalists also help families understand the prognosis and teach trainees how to communicate with families.
• The young woman who goes from a healthy student to severely psychiatrically ill to comatose in just a few weeks. Douglas says, "Sometimes this is autoimmune encephalitis, at times caused by a tumor on the ovary. We've seen enough of these that we know immediately to do a pelvic ultrasound, and if we find a teratoma, we can quickly get them into surgery. The improvement is often dramatic."

"Most neurologists spend about one month a year as an exclusively inpatient physician,” Josephson says. "For us, it's all we do, all year long. You can imagine how quickly the experience builds and translates to good quality care."

For more information, contact Dr. Andy Josephson or Dr. Vanja Douglas at (415) 476-1488. For the UCSF Transfer Center, call (415) 353-9166.