Preface

Preface “The only constant is change” – Isaac Asimov 1920–1990 The growth of neurohospitalist medicine was born out of necessity, with overwhelming numbers of patients presenting to the emergency department (ED) for acute evaluation of neurological symptoms, stressing the US health care system to the point of crisis. The demand for in-hospital neurological care will continue to escalate due to the aging population and neurologists' increased ability to impact disease. The demands on neurologists who maintain an outpatient practice while struggling to provide timely treatment of emergency and inpatients in an environment of decreasing reimbursement have driven many out of emergency call [–6]. Much like the internal medicine hospitalists before them, neurohospitalists have arrived as a solution to this difficulty. Neurohospitalists are specialists whose primary focus is the care of inpatients (emergency department, in-hospital and critical care) with neurological illness. Historically, some stroke neurologists, general neurologists and others have in many ways functioned as neurohospitalists. However, the neurohospitalist is ideally positioned to do more than just deliver care to individual patients. As part of an inpatient team, the neurohospitalist can focus on improving hospital systems, collaborate with other providers, improve transitions of care and develop quality metrics that accurately reflect outcomes. These areas of focus include both the critically important and common primary neurological conditions, and also the prevention and treatment of a wide variety of conditions that arise in the general medical, surgical, pediatric and obstetric patient populations. The purpose of this book is to provide a ready resource for those encountering inpatients with neurological disease, including health care providers of various specialties – emergency medicine, neurology, neurosurgery, hospitalists, internal and family medicine physicians, as well as residents, fellows, medical students, and physician extenders. This book is intended for physicians who care for patients in the hospital, emergency department and intensive care unit, regardless of training background, and is meant to be a resource as one rapidly evaluates and treats these patients with neurological disorders.