Specialty · Neurology
Neurology triage with a stroke pathway that fires on the first description, plus seizure protocols, migraine and headache triage, and monitoring for the drugs this specialty depends on.
In the product
Neurology line — inbound 11:07
EmergencyCaller
It's my father. He's gone very quiet and one side of his mouth is drooping. He tried to say something and it came out wrong.
Focal deficit language detected → stroke pathway, priority override
Primum
I want you to call 999 the moment we finish. First, tell me: what time did you last see him completely normal?
Caller
We had tea together. About twenty past ten.
Onset 10:20 · 47 minutes · within thrombolysis window · stroke team pre-alerted
Primum
That's important and the hospital will need it. Call 999 now, tell them stroke, last seen well at twenty past ten. Don't give him anything to eat or drink.
Stroke pathway
Emergency pathway complete · onset time transmitted · chart flagged
Overview
Every minute between the onset of a stroke and the door of a hyperacute unit costs tissue. The caller is usually a relative, they are frightened, and they rarely use the word stroke. They say one side of his face has gone funny, or she is talking nonsense, or his arm went dead and then came back.
Primum recognises those descriptions as what they are, immediately, and moves straight to emergency instructions with the time of onset established first — because that single fact determines what the receiving unit can do. Around that sit the specialty's programmes: seizure protocols, headache red flags, and the monitoring regimens that disease-modifying therapies and anticonvulsants require.
Capabilities
Two are emergencies measured in minutes. Two are programmes measured in years.
Facial droop, unilateral weakness, speech disturbance, visual loss and sudden severe headache recognised however they are described. Time of onset is established first, then emergency services advice, then the stroke team is alerted.
Duration, recovery, injury, first-ever versus known epilepsy, and rescue medication use. Whoever is present is talked through positioning and timing, with an unambiguous threshold for calling an ambulance.
Thunderclap onset, fever with neck stiffness, new headache over fifty, morning headache with vomiting, and headache with focal signs — separated from the migraine reviews that make up most of the queue.
JC virus screening, lymphocyte counts, liver function and MRI surveillance for disease-modifying therapies, plus anticonvulsant levels and the pregnancy-prevention checks valproate requires.
How it works
The pathway runs before anything else, because nothing else on the list is measured in minutes.
01
Patient matched with diagnosis, anticonvulsants, disease-modifying therapy and recent imaging loaded before the first question.
Neuro context
02
Language screened for focal deficit however it is phrased. Any positive finding establishes time of onset and moves immediately to emergency instructions.
FAST + onset time
03
Seizure, headache or programme protocol worked against your criteria, with findings coded and verified before anything is written.
Protocol + AHR
04
Stroke team or neurologist alerted, or the monitoring completed, the next test booked and the record updated.
Alert / write-back
01
Patient matched with diagnosis, anticonvulsants, disease-modifying therapy and recent imaging loaded before the first question.
Neuro context
02
Language screened for focal deficit however it is phrased. Any positive finding establishes time of onset and moves immediately to emergency instructions.
FAST + onset time
03
Seizure, headache or programme protocol worked against your criteria, with findings coded and verified before anything is written.
Protocol + AHR
04
Stroke team or neurologist alerted, or the monitoring completed, the next test booked and the record updated.
Alert / write-back
Benefits
Neurology's value is concentrated in the fastest and the slowest parts of the pathway.
Establishing when the patient was last well is the fact that decides thrombolysis. Asking it first, every time, is worth more than any triage refinement.
Therapies that need quarterly bloods for a decade fail on administration, not on efficacy. Keeping the schedule is the whole job.
Stable migraine reviews handled by phone frees the clinic for the new and the atypical, which is where the diagnoses are.
In practice
The first one never uses the word stroke.
Facial asymmetry with slurred speech, onset twenty minutes ago. Ambulance advised, onset time recorded, stroke team pre-alerted.
Typical for the patient, recovering, no injury. Recovery position instructions given and the neurologist notified for the record.
JC virus antibody due and MRI surveillance overdue. Both booked and the infusion confirmed against the result timeline.
New daily headache with scalp tenderness and jaw claudication. Giant cell arteritis criteria met and same-day review arranged.
The pathway is only worth anything if it fires on how people actually speak. Bring us your recordings and we will show you which descriptions it catches.