1. MOTOR NEURONE DISEASE IN THE EMERGENCY DEPARTMENT
HANNAH PRESTON, FY2
Royal Infirmary Edinburgh

2. BACKGROUND
Motor Neurone Disease is a non-curative degenerative neurological disease
Incidence in Scotland is 1-4/100,000
Men 3:2, Average age 60yrs, Fatal in 2-4 years.
It requires an MDT approach
Specialist nurses, consultants, OT, dieticians, GP, SALT
Most care is carried out at home with specialist input
Acute crises do occur and patients will present to acute services
May be related to unrelated to their condition

3. Emergency Department considerations
Many do not know about the complexity of the disease
Presentations may or may not be related to MND
Aspects to consider:
Oxygen
Locate next of kin
Do they have a care plan? DNAR? Advanced statement? MND alert card?
Do they have an enteral feeding tube?
Consider appropriate drug administration route
Do they use NIV?
Do they have capacity?
Contact MND specialist
They may not be able to lie flat for Xrays
Communication
Carer breakdown

4. AIMS baseline Reduce emergency admissions of MND patient by 30%
Reduce admissions of MND patients to general medical wards by 50%
baseline
Trak search from 2014-current
Presentations, admissions, progress and treatment

5. findings 18 led to admissions at least overnight (45%)
66 MND patients in Lothian
40 ED RIE presentations (2 had 4, 1 had 3, 2 had 2)
18 led to admissions at least overnight (45%)
MAU was the most common admission location
5 transferred to DCN at WGH (28% of >1day admissions)
1 rapid access clinic with neurology OP organised
2 sent to SJH
Of all presentations MND/neurology were involved from TRAK documentation in 8 patients (20%)
Occupational therapy were involved 2 cases prior to safe to go home from exam
3 for TTC follow up as outpatient with fractures
1 Head Injury and neurology observations

6. 3 new presentations and diagnosis of MND (7.5%)
No care plans on trak- used for complex patients
4 admissions clearly documented for not coping in current situation
No protocol on EMIBANK or advice for MND patients for ED staff

7. REASONS FOR PRESENTATION

8. Future changes
Teaching session to Emergency Department staff- delivered by Dr Davenport and Judith Newton
To create care plans for all MND patients on TRAK
Create a pathway on EMIBANK for staff to use and follow
Phone numbers to call in and out of hours
Liaison nurses for advice
Home ventilation team numbers accessible
Monitor admissions for evidence of improvement once implementations have been out in place

10. Thank you for listening… how do you feel we can improve?