1037 Informal Consultations in Neurosurgery: Results of a Council of State Neurosurgical Societies Survey

INTRODUCTION: Neurosurgeons are often asked to give clinical advice to other physicians through curbside consultation and are also considered as the gatekeeper for whether to accept a patient transfer with a neurological condition. Such interactions occur prior to establishment of a direct doctor-patient relationship. However, recent legal cases ruled that a doctor-patient relationship is not a necessary element of medical negligence claims in certain state(s), rendering potential medico-legal liability through such transactions. METHODS: The Council of State Neurosurgical Societies surveyed practicing AANS-registered neurosurgeons via email link using the SurveyMonkey platform to assess practice pattern and frequency of transfer requests and informal consults. One hundred fourteen responses were obtained. RESULTS: Of the 114 survey responses, most of the respondents were either employed by a hospital/hospital foundation (32%) or in an academic practice (28%). Ninety-four percent of respondents participated in trauma neurosurgery calls. Most frequently, the on-call neurosurgeon would get 2-3 transfer requests (47%) per day. Similarly, respondents typically received 1-3 curbside consults (66%) per day. While most curbside consults came from the primary call hospital, 21% of the respondents also participated in curbside consults from out of state. Majority (69%) of the respondents were able to document the transfer requests through a recorded conversation with the transfer center. Notably, 71% of the respondents did not document their curbside consultation interaction. Importantly, 7% of respondents reported having had a malpractice lawsuit or medical board/hospital complaint against them arising from curbside consults. CONCLUSIONS: Transfer requests and informal consults are common aspects of neurosurgical practice. However, the lack of complete clinical and radiographical data available to the neurosurgeon for clinical decision-making and the lack of documentation expose the providers to potential medico-legal consequences.