What happens to the patient if a neurointerventionalist screws up?

[samsoccer7]

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A radiology resident at my school and I were having a conversation about my future plans. I told him about neurointervention and he seemed a bit skeptical of its future. He gave me a scenario:
"Any neurointerventionalist who spend even 1/2 his time doing procedures will have complications... what happens to his patient now that he has to consult neurosurgeons (from whom he has "stolen" the job) and they're not so happy about it and give the "told ya' so" bs."

I see his point... Do the interventionalists take care of the patient in the ICU then? I know the programs require rotations in neuroICU and step-down, but is that enough to manage your patient complications assuming further surgery is not required?

 

[Voxel]

Page neurosurgery stat, just like the cardiologists do when they perf a coronary artery.

 

[RADRULES]

Complications are a known risk of NIR.... you will stroke out patients. You just have to be prepared for it. In any case, we have never had problems with NS in this regard.

 

[Tenesma]

i think one of the problems amongst most practitioners is the firm belief that the person providing the procedure should also manage its complications or at least the further care of the patient.... or at least that is how the majority of surgeons view procedure oriented specialties... We often forget that the interventionalists are just that, they are for the most part technicians who are providing a medical service after being requested to do so by either the primary care giver or another specialist... While I admit that it is frustrating when a GI doc perfs the colon and we have to rush the patient to the OR, when a NIR does a vertebroplasty on a pt who subsequently has an MI, etc... nobody screws up on purpose and the patient consents to the procedure knowing (hopefully) that there are substantial risks... and trust me there are many non-procedural screw ups that can be a headache or even worse a true burden, think of the internist who miswrites a presciption for an anti-hypertensive, the resident who gives demerol to a patient on MAOIs... mistakes happen... what matters (and this is important legally) is prompt recognition of the complication and the prompt treatment, as soon as the lawyers can prove there was a delay in diagnosis or treatments your wallets will be emptied - as they should be

 

[samsoccer7]

Those are good posts and I appreciate the responses. I'm playing more of a devil's advocate, but I think for a good reason.

Neurointerventionalists sometimes take patients neurosurgeons would like to have (GDC coiling vs. clipping) and so a turf battle is born.

Now, when a gastroenterologist punctures the small bowel during ERCP, the general surgeon or colorectal surgeon will take the patient and do whatever they need to. There is no problem, b/c there's no turf battle to begin with.

However, with neuro, it seems the surgeons would be pissed when all of a sudden they have to manage some else's patient b/c the interventionalist messed up (but still within normal complications). Is this a problem at anybody's institution? Do you think this will ever be a significant problem where neuroIR's have to rely on their "competition" to take care of patients?

 

[droliver]

To get IRB approval for procedures like that, one of the conditions is available backup for complications. If the NIR's are doing it somewhere, these issues have been sorted out. It is likely however, that at some programs with strong & active neurosurgical services that do coiling they will play hardball on it. It's already happened with vascular surgery and IR in some places.

 

[samsoccer7]

For once the IRB seems to be in my favor 🙂