“Establishment of an acute headache infusion clinic as an alternative for emergency department care”

Objectives: Numerous patients receive acute migraine care in the Emergency Department (ED) setting. A shift of this care to the outpatient Neurology Clinic and outpatient Infusion Center setting has the potential to optimize clinical management while decreasing resource utilization. Methods: Clinicians and administrators collaborated on the operationalization of an Acute Headache Infusion Clinic run through the outpatient Neurology Clinic. Data was collected on all patients treated in the Acute Headache Infusion Clinic from 9/2018–12/2019. Duration of the outpatient visit, cost per visit, and pre- and post-treatment pain scores were collected. Comparison was made to similar care administered at our institution's Emergency Department. Results: Results from 133 patients were obtained. The outpatient encounter was 3.73 h shorter than the ED encounter and was associated with a cost savings of ~$9400/patient. Patients experienced a substantial decrease in their pain scores with treatment in the outpatient setting. Conclusions: The transition of acute migraine management requiring infusion therapies can successfully be transitioned from the ED to the outpatient setting. This can be associated with shorter clinical encounters with more optimal resource utilization while still providing adequate headache relief. Classification of evidence: This study provides Class III evidence for an outpatient infusion clinic for saving costs and clinical care time for patients with acute migraines requiring infusion therapies.