If the patient may qualify for neuroendovascular (NES) intervention, the stroke attending or fellow will discuss the case with the neuroendovascular surgeon. If they agree to activate the NES team, a series of pages will go out to the angiography suite technologists and nurses, the anesthesiology team, and others to prepare for the possible intervention. You’ll be included on these pages to keep you in the loop; the series of pages is described below.
Some NES cases arise from inter-facility transfers. In those cases, your fellow and/or attending will have already discussed the case with the referring physician, arranged for transfer to our ED, and notified the NES team.
NES page #1: This is the initial notification that there is a potential NES case. Example: “NES code, patient William Smith coming from Baraboo. ETA 60 minutes”. Or: “NES code, patient Jane Doe in the UW ED room #1”. When you receive the NES page about an outside patient, that will be your prompt to call your fellow or attending, who will fill you in on the details of the case.
NES page #2: For patients coming via inter-facility transfer, this page is sent by the ED staff upon the patient’s arrival. “NES code, patient William Smith arrived in ED room #2” or even better, “ETA 10 minutes”. That’s your cue to proceed to the ED to assess the patient, see that he goes quickly for CTA, and report back to your fellow or attending regarding your initial findings. Is the initially-ascertained time of last known well correct? Does the exam still show severe deficits, or did the patient get better while en route?
NES page #3: Once you, your attending, and the NES team have evaluated the patient and the imaging, a go / no-go decision will be made. “NES code patient William Smith is a GO”.
NES page #4: The angiography suite staff will send this page when the room is ready.
Following are the triage pathways for possible endovascular cases: