After a careful reading of the comments made by Vázquez Lima et al. on our article addressing the workload of on-call emergency room neurologists at Hospital Gregorio Marañón, in Madrid,1 we wish to thank the authors for their interest.
We feel that the idea that local and medium-size hospitals have lower mortality rates in emergency departments and shorter acute care delay times than tertiary centres, which is based on the SUHCAT study,2 is biased if we do not consider the complexity and severity of the patients treated in major hospitals. How could patient care possibly be worse in that setting? Care provided at different levels cannot be the same, and the more specialised the team, the better the care it provides to patients with complex or severe neurological cases.3
The purpose of our study1 was not to promote a particular specialty, but rather to highlight the relevance of neurologists in the emergency department of a high-level hospital and underscore the need for emergency neurological care in other tertiary referral hospitals. The workload figures provided in our study correspond to emergencies.
Unfortunately, the example of acute coronary syndrome is not comparable to stroke since stroke requires neuroimaging studies to provide treatment during the acute phase. Furthermore, types of stroke care other than stroke units, such as stroke teams, have not shown any benefits.4
The purpose of a clinician, whether specialised or not, is to provide effective and efficient care to patients. Care must be sustainable, but also equitable; we therefore agree that a ‘nodal structure’ or other organisational strategies similar to code stroke should be implemented to ensure that neurological patients are transferred to hospitals offering emergency neurological care.5
Lastly, the conclusions drawn in our study refer to high-level hospitals such as our own, since we understand that they may not apply to all types of hospitals.
Please cite this article as: Rodríguez Cruz PM, Díaz Otero F, Ezpeleta D, García Pastor A, Gil Núñez A. Labor asistencial del equipo de guardia de neurología en un hospital terciario de Madrid: análisis prospectivo durante un año. Contestación a réplica. Neurología. 2016;31:574–575.
