Lahey Consult Resident

Goals and Objectives:

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1. Improve in knowledge of all aspects of neurological disease prevention, diagnosis, counseling, and management.

2. Develop team leadership skills.

3. Mastery of effective triage.

4. Management of neurologic emergencies.

5. Graduated autonomy in initial assessment and plans for patients.

6. Serve as an educator to medical students, patients/families, and junior residents.

 

Responsibilities:

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• Arrive at 7:00 AM for sign out from the Night Float Resident. Sign out occurs from 7:00-7:30 AM.

• Divide the neurology consult patients with the Junior Consult resident. The Junior Consult resident is allowed a cap of 4 follow-up patients and 4 new consults. At any given time, the Senior Consult Resident should carry 60% of follow ups, new consults, and stroke codes.

• The Senior Consult Resident is expected to carry the consult pager and a stroke pager throughout the day. The Junior Consult resident is also expected to carry a stroke pager. It is the role of the Senior Consult resident to delegate consults to their Junior Consult resident and Medical Students.

• The Senior Consult resident is expected to contact the Consult Attending directly in a time-appropriate manner if there are any urgent issues requiring immediate decisions that the Senior Consult Resident is not comfortable making independently.

• If the Consult attending cannot be reached immediately then the Senior PGY-4 resident on the inpatient service should be contacted for assistance.

• All consults in the emergency department must be staffed with the attending on call before being discharged.

• All consult notes must be completed the same day.

• Pre-rounding occurs from 7:30-8:30 AM separately between the junior and senior consult residents on the patients they are following. Formal consult rounds with the attending physician should begin no later than 9:00 AM.

• Formal rounds include the Senior Consult resident, the Junior Consult resident, Consult attending, +/- Medical Students.

• If a new consult or stroke code arrives in the morning, one of the residents may break away and complete the consult with the remaining resident continues rounds with the Consult attending. 

• The Senior Consult resident should be available to the Junior Consult resident and medical students to make a preliminary plan and to supervise prior to formal staffing with the attending physician.

• The Senior Consult resident will be responsible for teaching which may include, but not limited to:

  • Bedside neurological exam

  • Clinical Pearls

  • Lumbar punctures

  • Interpretation of imaging

  • Forming differential diagnoses and management

• The Senior Consult Resident workday ends at 5:00 PM on weekdays; however, in cases of emergency, short-staffing, unstable patients, or additional assistance is required, the Senior Consult resident is expected to stay after hours in such circumstances.

• Any consult received prior to 4:30pm is expected to be seen by the consult team. On rare exception should these consults be passed on to the long-call resident.

• The Senior Consult resident must sign out to the long-call resident regarding any patients that require follow up after the end of their shift or patients in the emergency room with dispositions pending the results of tests. The resident must finish staffing all consults prior to leaving the hospital. 

• On Friday afternoon, the Senior Consult resident should complete their work prior to leaving for conference. The Senior Consult resident is not expected to see any consults after 11:00am if the conference is at Tufts Medical center to allow to time for transportation. If the conference is at Lahey Clinic, then the Senior Consult resident is not expected to see any new consults after 12:00pm.

• On the weekend, the Senior Consult resident is required to round independently on the General Neurology Inpatient service. After enactment of the plan for the General service, the senior must touch base with the junior resident to determine if any assistance is needed. It is at the senior resident’s discretion to leave early if the wards and the work of the junior resident is stable.

 

Format for Rounds:

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• For each patient, the following format is recommended:

1)  The Junior or Senior resident will present a concise and through pertinent history:

• Example: “A 34 year-old woman with a PMH of SLE presents with 1 week of double vision. Initial neurological exam was notable for Cogan sign, curtain sign, fatigable extraocular eye movements with dysconjugate gaze and associated binocular diplopia”.

2) The Junior or Senior Consult resident will present overnight events, vitals, morning exam findings, and pertinent labs/imaging.

3) The Junior or Senior Consult resident will create and discuss the preliminary plan along with the Consult attending outside of the room.

4) The Senior or Junior Consult resident will perform the physical exam with the supervision of the Consult Attending.  

5) The Senior Consult resident or the Consult attending should communicate the preliminary plan with the patient.

6) After exiting the room, the Senior Consult Resident and the Consult Attending should provide one teaching point to the resident regarding the case (pathophysiology, treatment, localization, differential, prognosis, etc).

7) The Senior or Junior Consult resident must contact the primary team to directly provide the recommendations.

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The Lahey Consult resident works with the Lahey Consult attending to take care of all patients on the Neurology Consult service. The resident is expected at arrive by 7am for overnight sign out and to take over the stroke pager. Before 7:30am conference, the resident should make every effort to briefly see all follow up patients on the list and address any urgent issues. After morning conference, the resident should contact the attending to run the list and make a plan for the day. As new consults come in, the resident should promptly see them, then staff with the consult attending. All plans should be directly communicated to the primary team. In no case should a resident refuse to see a consult. At noon, the stroke pager is given to the Stroke Junior. The consult resident will continue to see new consults until 5pm. At that time, the consult pager is signed out to the long call resident. If a patient is admitted to one of the inpatient Neurology services, then formal sign out must be given to that team. All notes should be completed before leaving for the day.

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How Consults should be conducted:

ED Consults

Floor Consults