I. Problem/Challenge.

Hospitalists will likely be increasingly responsible for the co-management of neurosurgical patients and should be familiar with the most common neurosurgical procedures and managing potential medical complications.

II. Identify the Goal Behavior.

III. Describe a Step-by-Step approach/method to this problem.

Pre-Operative Evaluation

Step 1: Determine Revised Cardiac Risk Index (RCRI) score

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Step 2: Assess patient’s functional exercise capacity

Tumor Resection

Intracranial Hemorrhage

Spinal Decompression and Fusion

DVT Prophylaxis

IV. Common Pitfalls.

Anticoagulation and antiplatelet therapy:

– Discuss with neurosurgeon before starting anything that could increase bleeding risk

Volume management in patients with subarachnoid hemorrhages:

– Balancing risk of vasospasm with cardiopulmonary status

Antihypertensive management:

– Titrating BP meds too fast

Long-term steroid use:

– GI prophylaxis, glycemic control, counseling on muscle wasting/confusion/increased bleeding risk

V. National Standards, Core Indicators and Quality Measures.

No national standards/benchmarks established yet.