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Introduction
Acute relapses in multiple sclerosis (MS) represent foci of acute inflammation and demyelination within clinically eloquent areas of the central nervous system (CNS).1 It is important to recognise and to assess people with MS relapses to establish their clinical diagnosis,2 optimise short-term ability,3 guide longer-term treatment decisions4 and inform on the natural history of disease.5 Historically, neurology services have been poorly organised to meet the needs of patients with an acute deterioration in MS symptoms. However, a dedicated service for patients with symptoms suggesting MS relapse shortens the delay in accessing specialist care and receiving treatment, reduces inpatient admissions and minimises the psychological impact of MS relapses.6 As a result, UK national recommendations now suggest that patients experiencing relapse should have rapid access to outpatient specialist MS care.7–9 Thus many specialist centres have developed open, rapid-access services that may vary in design, but which allow people with MS and acute neurological dysfunction to receive prompt expert assessment.
Service model considerations
In a typical rapid-access service model, patients self-refer; however, the service should also incorporate referrals from multiple sources, including general practitioners and hospital subspecialties (figure 1). Patients need signposting to self-referral routes at the time of their diagnosis, and reinforcing at subsequent points of contact. Methods of informing patients or general practitioners about referral routes include verbal or written reminders (eg, leaflet) provided at specialist clinic appointments, adding emergency contact details to the standard clinic letter header, or including emergency MS contact details within the hospital website. Referral routes might include telephone, text message or email, checked each working day. Telephone triage can efficiently deal with referrals promptly and identify those patients who might be best served by a face-to-face evaluation. Patient calls are best returned by an MS specialist nurse or an appropriately experienced clinician …
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