Reader Question: Is it common practice for a STEMI team to also be on call for trauma and neuro emergencies, and if so, how do you make it work?

 

“Greetings. I belong to a cath lab that is part of a large hospital system and have a concern about utilization of our STEMI call team. We have done IR procedures since the cath lab opened just over 14 years ago, so have traditionally taken call for STEMI and IR procedures. However, most of our IR procedures had not been what would be considered ‘life-or-death’ situations. There would be the occasional GI bleed or cold limb, but most of our call-ins were for nephrostomy tubes, IVC filters and PICC lines.

 

“We recently received our Level II Trauma certification, which meant having to have a call team to respond to traumas in need of embolization — truly the ‘life-or-death’ patients. Since the IR team in our facility doesn’t have an angio suite and doesn’t take call, trauma call fell on the cath lab, too. We have already had a conflict, a STEMI and a splenic fracture within minutes of each other. Because the STEMI patient coded as we were taking him off the table, the splenic fracture had to be taken to the OR, which has greater potential for complications and was not what the trauma surgeon wanted.“Now we have learned our hospital is looking to achieve Comprehensive Stroke Certification sometime this summer. That means having a team on call for neuro. Although no one has said it in so many words, the cath lab is expecting this to also fall on them. It would have to, as there is no other department within the facility that has the equipment or the trained staff to do neuro procedures. 

 

“I’m sure it’s clear why this is so concerning, as it adds yet another potential conflict in an emergent situation. My question to other cath labs is this: is it common practice for a STEMI team to also be on call for trauma and neuro emergencies, and if so, how do you make it work? In a small lab, a backup team is not a good solution because there is already such a large call commitment. Everyone who has worked in a cath lab knows how precious those evenings and weekends are when you don’t have to worry about your phone ringing or your pager going off. Even with STEMI call alone, call burnout is the #1 reason people change career paths after a few years.

 

“We have always been the cath lab eager to take on any new challenge or procedure, and neuro is a very interesting specialty. We want to be able to say yes, but feel this is a risky undertaking that could have catastrophic results. I would love some feedback from other labs on ways this could be managed in our facility.”