From: Allen Hayman
Sent: Thursday, July 25, 2013 10:27 AM
To: John Allyn; Anes S All Physicians
Subject: RE: Lumbar puncture
I have a question since I'm relatively "new". I'm assuming that we will be asked to do the LP. Since this is a procedure (like an epidural for broken ribs), we would not be able to do this while supervising rooms correct? Is this at a level that we would call in the L1 prior to saying that we are unavailable and have this shunted to fluoroscopy? Or would we give the request the standard answer: we are currently busy, I see a potential opening in 4-6 hours (as the OR dictates) I may be able to do it then but no guarantees.
The policy was vague from our standpoint about our availablility. Guidance?
Allen Hayman
From: Jim Pisini
Sent: Thursday, July 25, 2013 12:45 PM
To: Allen Hayman; John Allyn; Anes S All Physicians
Subject: RE: Lumbar puncture
Allen,
I'm glad you asked this question as I was unclear after reading the "policy" as well. This is my take on it.
First off, many physicians and advanced practitioners have the training andprivileges to perform this procedure: ER docs, Pediatricians, Neonataologists, Neurologists, Neurosurgeons,PA's and NP's in some specialties, Anesthesiologists, and probably numerous others I am missing. We are not the onlyspecialty in the hospitaluniquely qualified to perform a lumbar puncture. In fact, it isextremely rare that we do it. To say that performing a spinal anesthetic is the same as a LP is a gross overstatement. I would guess that a vast majority of anesthesiologists would not know all the steps involved with performing a diagnostic LP and believe me, it is crucial. It's not just sticking a needle in theintrathecal space.
If a trained and qualified provider is unable to perform the procedure, then I don't think we should be their "back-up". I agree with having a Neurologist as the initial back-up as they routinely perform this procedure and most likely would have more insight into the neurologic signs and symptoms that the procedure is being done for in the first place. They might also need to get involved with the patient's care. If they "can't get it", then why us? At that point, by definition,it is a difficult access problem and hence radiologic guidance and expertise is needed and should be employed. I assume that is why the policy was created in the first place. Personally, I think we are an unnecessary step and shouldn't bein thealgorhythmjust for convenienceor as another hurdle to jump before requesting radiology. Others might not know that we cannot perform a procedure while concurrently directinganesthetics so communication with them might be helpful as well to explain the burden it puts on us.
This is my opinion for coverage at MaineMedicalCenter. I think the smaller community hospitals we cover are a different situation and should be addressed on a case by case basis depending on our availability. We very well might be the only back-up available in a small, rural hospital.
Again, just my opinion but I agree, the vagueness needs to be addressed.
Jim
From John Allyn, Chief
Thursday July 25, 2013
Policy has been in effect for a while and is vague on purpose - i.e. commits us to help when we can. I think we now have more email about this than we have requests for LP help since the policy was written - latest edit by Charlie Grimes in 2012 I think asked that the patent havecoag studies done if appropriate before requesting help.
To Jim's point, I would recommend that the requesting team be present and once the IT space is accessed, they can take over the procedure with measurements, collection for and ordering of tests..
thanks
John