Don’t Wait for a Neurointerventional Disaster

WHAT

An early, proactive review can help hospitals avoid pitfalls that can plague new neurointerventional services.

A SPECIALTY GROWS UP

Originally developed within the specialty of radiology, neuroendovascular interventions may now be called neurointerventional radiology, interventional neurology, and neuroendovascular surgery, depending on the training of who is holding the instruments. Catheter-based endovascular brain procedures are now being performed by neurologists, neurosurgeons, and radiologists who have completed highly specialized endovascular fellowships. As increasing numbers of clinicians have completed their advanced neuroendovascular training in the last decade, more centers are now offering endovascular-based neurovascular care.

This is good news for patients, who can expect lower death and disability rates than with traditional therapies. Neuroendovascular therapies are still evolving and are under continuous study, but are becoming standard of care where they are available, particularly for select cases of stroke, intracranial hemorrhage, and brain aneurysms. Less commonly, interventional approaches may be the treatment of choice for certain tumors, arteriovenous malformations, arteriovenous fistulas, and certain causes of seizures. More than half of brain aneurysms are now treated via coiling. For certain patients with acute stroke, urgent endovascular approaches to removing or lysing clots and restoring blood flow can offer better outcomes than medical therapy alone.

WITH GROWTH, GROWING PAINS

But these state of-the-art procedures are also high-risk, and things can go wrong.

One option for medical centers is to open a new program, relying on the expertise, experience, and judgment of its leadership, and hope for the best.

Another is to follow the lead of forward thinking, quality focused directors who prefer not to wait until disaster strikes. Some hospitals who have recently begun neuroendovascular programs are choosing to evaluate their fledgling programs proactively, before potential problems may present as suboptimal outcomes or near misses.

In the past year, hospital and medical staff leadership from several centers have approached MDReview to request a review of early cases. In particular, the centers wanted objective evaluation of patterns and processes such as:

• Were they selecting appropriate patients, i.e. at the correct risk level? Did they meet the criteria for intervention?
• Which guidelines are best at identifying appropriate patients for interventions, both elective and emergent?
• Were optimal procedures being used?
• Were the department’s policies and procedures correct and effective in ensuring best practices?
• Is the center’s documentation appropriate?
• Are the center’s outcomes acceptable?
• Is the facility prepared to manage unexpected findings and emergent developments?