Neurohospitalist scope of practice

[neurores2020]

---

Members don't see this ad.

Thanks in advance for the replies.

I know each job varies considerably, such as consult only vs co-manage vs primary service, 7/7 vs 14/14 on/off, guaranteed income vs RVU, teleneurology or telestroke in place to handle overnight stuff vs you being "on" 24/7.... I'm specifically asking regarding management of the different types of head bleeds when working as a general neurohospitalist.

For instance, in residency at my institution if someone has a traumatic SDH, epidural, or SAH from an aneurysm they all go to neurosurgery and we have little to no involvement in the care. But, we (neurology) handle all the IPH's (unless it is AVM). If they need an EVD or whatever neurosurgery will do the procedure and we are still their primary management team.

In the real world as a general neurohospitalist ( ie no NCC fellowship, just straight out of residency), is there also a general divide such as this?

 

[Algor]

Most of the time (99%) you will not be an admitting attending.
So, the patient will be admitted to ICU and neurosurgery will be consulted. That is not your job to consult neurosurgery, should be done by ER or primary.
You evaluate the location of the bleed, possible etiology, may consider advanced neuroimages, such as CTA, give recommendations regarding blood pressure parameters, q1-q2 hours neuro checks, recommend stat head CT for any change in neuro exam and recommend to call neurosurgery for any change in bleed size, elevated head of the bed at 30 degrees.
Also, all coagulopathies should be assessed and corrected by ER/ICU attending.
That is pretty much 80-95% of all your "brain bleed" consults. If we are talking about subarachnoid hemorrhage, it is more complicated, but most of the time vascular neurosurgery is managing it, again, you can recommend all above + some CCB. Most of the patients with SAH will be in neuro ICU with neurointensivist on board. If the patient is not waking up, you can get EEG. Not too complicated, hah?