1441. Understanding the Nature of Neurosurgical Acute Care Call

Authors: Gary Robert Simonds, MD, FAANS; Cara Rogers; Chris Busch; Lisa Apfel (Black Mountain, NC)

Introduction: Neurosurgery as a specialty bears the burden of a substantial volume of acute care call. Neurosurgical call is almost uniformly looked on negatively by those who must provide it. We are interested in the impact call has on provider wellbeing and resilience. We sought to probe the nature of a “typical” night of neurosurgical call at a busy acute care/trauma center in hopes of isolating factors that may particularly contribute to providers’ associated dissatisfaction. Methods: We asked neurosurgical residents and advanced care practitioners (ACP’s) at our institution to log every action engaged through their nights of neurosurgical call. These actions were collated and organized into various groupings. Providers were interviewed and surveyed about their responses to the various types of actions, activities, interactions. Results: 16 neurosurgical residents and ACP’s participated. Providers logged an average of 48 critical interactions per night of call with a high of 78. Emergency consults per night ranged from 7 to 20. “Stacked pages” were common, as were “hammer pages.” Critical discussions with pre-existing patients or their families averaged 8 per night. Longest uninterrupted periods of sleep were estimated to be 30 minutes. Most respondents noted profound difficulties sleeping, even on “quiet nights.” Average amount of sleep on-call was 0-1 hour. Providers estimated that ¾ of the night time consults did not require urgent neurosurgical evaluation. Providers reported great frustration with these types of consultations. All providers reported no negative feelings associated with bona fide urgent/emergent consultations. Similarly, “nonsense” phone calls precipitated high levels of frustration, anger, and even rage. Conclusion: Acute neurosurgical call can be taxing and aggravating and a substantial challenge to provider wellbeing and resilience. Methods to limit the unnecessary tasks, consults, and calls experienced by on-call providers may serve to lessen some of the negative impact.