Neurosurgery Admission

• Postoperative complications from recent surgeries
• Established patients sent to ED for expedited surgery/interventions
• The hospitalist team will consult and co-manage all patients.
• Surgical ACP hospitalists/ACP nocturnists can be utilized as surgical specialists to evaluate wounds and communicate with on-call neurosurgery ACP (i.e. pictures of wounds, dressing recommendations) for interim, stabilizing care until patient can be evaluated by neurosurgery following day.

Medicine Admissions

• Non-operative spine consults. (i.e. stable spine fractures such as compression fractures, chronic degenerative spine disease, herniated discs without neurologic deficits).  Neurosurgery to document no planned interventions this admission
• Non-operative downgrades from ICU (i.e. traumatic subarachnoid hemorrhages, small non-operative subdural hematomas).  Neurosurgery to document no planned interventions this admission
• Metastatic brain tumor patients
• Any documented neurosurgery consult that does not require urgent surgical intervention, or planned surgery during this admission

Transfers to Neurosurgery Service

• Any spine/cranial case initially admitted to medicine and following additional workup, surgical intervention has been recommended and agreed upon by patient/family

Case by Case Discussion and Escalation Process

• Newly diagnosed brain tumor patients in which there are isolated neurologic issues and no systemic issues requiring aggressive medical management
• Discussion regarding admission disposition shall occur between neurosurgery ACP/attending neurosurgeon and hospitalist group directly.  ED being used as intermediary for discharge disposition NOT advised
• If disagreement or discrepancy between neurosurgery ACP and hospitalist, discussion is escalated to neurosurgery attending