Schedule

• Sign-out is at 7am for any overnight events and new patients. This is typically brief, since night float also has to sign out to the attending after morning report.

• Sign in to pager 6500, print your list. Pre-rounding is expected only for complicated or sick patients.

• You should attempt to run through the consult list with the senior/attending after morning report to know who to focus on in your rounds.

• While the rest of the team has ward rounds, the consult resident should see new consults and follow-up on prior consults. The consult resident should see any active patients (and all ICU consult patients), and the encounter along with the recommendations must be documented in Sorian.  It is good practice to document even attempts to see patient, e.g. you went to the room, but the patient was gone for testing or the like.

• Update the sign out before leaving for the day.  You are also expected to sign out any pertinent consults to the long call (if it's not you that day) or night float resident. 

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Responsibilities/Expectations

• Your responsibilities include (get ready, it's a long list):

  • Seeing any active follow up and ALL ICU follow up consults, ​staffing with the attending, writing progress notes, and relaying recs to the team. 

    • This includes stroke, neuro-oncology, general , or ICU consults. ​​

  • Seeing all new consults, with timing determined by level of acuity, writing consult notes, ​staffing with the attending, and relaying recs to the team. 

    • This also includes stroke, neuro-oncology, general , or ICU consults. ​

  • Stroke codes all day, and admitting them if needed which also includes writing the H&P, admission orders, as well as signing them out to the floor or ICU team. 

  • Coordinating rounds with the 3 different attendings. 

  • After 5pm, and on weekends, you may get calls from outpatients - if they have a question or complaint, the response should almost universally be "come to the ED" unless you're VERY confident that they're totally fine. If they want a refill, it's usually fine to send a few days' worth of anything, but use your judgement. Regardless, make sure you write a telephone encounter in eCW and route it to the patient's primary neurologist (see eCW tips for details). 

  • After 5pm, and on weekends, you may also get calls from outside hospitals - if they want to transfer a patient, tell them they need to talk to the on call attending - we can't accept transfers as residents. If they want advice (this happens rarely), say you're not able to give advice over the phone because you haven't seen the patient; if they insist, they can talk to your attending about possible transfer. Be careful with these people - they will write down your name and put in the chart "Per Dr. BlahBlah at Tufts neurology, given 10,000 mg Keppra, now has drowsiness of unclear etiology" even if it's not true, so it's better to say nothing at all. 

• Any consults placed within 30min of the following shift can be signed out to the following shift unless they are urgent or are stroke codes. All consults prior to 30min to end of shift are expected to be done unless you are inundated with consults.

• Make sure you call back any pages within 5-10 minutes.

• Daily progress notes are required for all active consults, (i.e. MRI pending, on LTM EEG, etc). This consists of daily physical exam and recommendations. This is expected even if the attending does not see the patient and therefore doesn't write a note (this is a Tufts neurology policy that they don't need to see the follow up patients). All ICU level consults regardless of perceived level of involvement from neurology must be seen and have a progress note documented daily with recommendations until we have officially signed off. 

• If the patient is not active, sign off but state in your note that the team can be paged if there are further questions or concerns.  It is better to sign off and return to a patient then to let the primary team think you are actively helping to manage the patient.

• VERBALLY communicate recommendations with the primary team (final recommendations should also be updated in the consult/progress note).​

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Workflow Tips​​

• SIGN OFF AS QUICKLY AS POSSIBLE! The longer your list, the more work you have to do. Ask the attending every day if we can sign off.

• Rotators can be used to your advantage - simple/bread-and-butter cases for medical students, more complicated new consults for psych/medicine residents. Use your triage skills, and see anything urgent or very complex yourself. Dr. J follow ups are usually easy and can be given to med students. This will leave you time to see the more difficult/complicated follow-ups. Note that even if someone else saw the patient initially, you are carrying the pager and thus need to know the patients and the recommendations and you are responsible for ensuring that notes are done and recommendations are relayed appropriately. 

• It's helpful to ask for a callback number when someone pages you so that you know who to give recs to once the patient has been staffed. 

• Don't be afraid to ask your senior for help with triage, answering team questions, coordinating rounding logistics, or even helping out with consults if you're swamped. 

• You can take ownership of basic teaching of neuro exam and acute neurology basics for rotators on the service (e.g. medical students, psychiatry and medicine residents), although this is primarily the responsibility of the senior.

• By far the most difficult part of this rotation is coordinating the attendings. General/ICU consults are staffed by the ward attending, stroke consults by the stroke consult attending, and neuro-oncology consults by Dr. Jeyapalan. The ward attending has ward rounds in the morning, the stroke fellow/attending have clinic in the afternoon, and Dr. J's schedule is completely erratic. They all will want to round separately (and often ask for simultaneous times), so you need to coordinate the schedule on a daily basis to make sure everyone is seen. 

  • Dr. J is NOT allowed to round after 5pm (this was previously a problem) - if she rounds later than this, she has been told she needs to round without a resident.​