Objective: To assess whether proactive electronic case finding and front-door specialist review reduced reliance on ICE (Electronic Inpatient Referral) and improved time from admission to first specialist PD review.

Background: People with Parkinson’s disease (PD) are vulnerable to inpatient harm, including delayed time-critical dopaminergic medication, dysphagia, delirium, falls and deterioration. Referral-dependent models can delay specialist review by 24 – 72 hours and miss early optimisation and prescribing safety. National guidance and audit data show persistent variation in acute PD care. We redesigned our inpatient pathway to a proactive specialist-led front-door push model using virtual-ward oversight to identify and review PD admissions early.

Method: We compared a baseline ICE referral triggered inpatient PD pathway with a post-implementation proactive specialist-led model using virtual-ward oversight to identify admissions and enable same day review where possible. Weekend admissions were reviewed within 24 hours (48 hours for Saturday). Outcomes were ICE referral volume and time from admission to first specialist review (Jan to Nov 2025).

Results: In the baseline year, there were 354 ICE referrals (monthly range 20–39), reflecting reliance on primary-team referral. After implementation of proactive case-finding and virtual-ward oversight, ICE referrals fell by ~78%, consistent with the shift from referral-triggered review to specialist-led identification. For Jan to Nov 2025, time to first specialist review was: 59.5% <24 h, 20.3% 24 – 48 h, 9.3% 48 – 72 h, and 11.0% >72 h. Overall, 79.8% of admissions were reviewed within 48 h and 89.1% within 72 h, indicating improved early access to specialist input under the proactive model.

Conclusion: Our inpatient PD pathway shifted from a reactive, referral-dependent model to a proactive specialist-led RRPD service supported by virtual-ward oversight. This enabled early review for most admissions, moved specialist input to the front door, and reduced reliance on primary-team referral. The approach is practical and scalable to improve the timeliness, reliability and safety of acute PD care.

Shift in review location: wards to front door

Timeliness of first PD specialist review (post)

References: 1.NICE. Parkinson’s disease in adults (NG71).
2.NICE. Parkinson’s disease quality standard (QS164).
3.Parkinson’s UK. Get It On Time / Every Minute Counts / National Parkinson’s Audit.
4.Parkinson’s Foundation. Hospital Care Recommendations for People with Parkinson’s Disease.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/transforming-acute-parkinsons-care-impact-of-a-proactive-specialist-led-front-door-rapid-response-parkinsons-service-rrpd/