Do you refer all patients with new findings of CNS or epidural disease to ED for evaluation or are there some that can be managed completely outpatient?   

E.g., patients with small CNS mets without vasogenic edema or symptoms.   Epidural disease without epidural spinal cord compression or asymptomatic low grade ESCC.  Reflexively referring to ED can be erode trust if they are not receiving much care in ED or inpatient.   Also question the role of empiric steroids and AEDs in these cases?