Basics

Each resident will spend 8 weeks total in the NCCU at Tufts during residency, usually a month as a PGY2, and another as a PGY3. This is a chance to learn to care for critically ill neurology patients and also neurosurgery patients, which is important as the distinction between the two often blurs. The unit is a shared neurosciences unit. This is our exposure to neurosurgery, so take advantage of it. Ask as much as you can of the neurosurgeons, particularly the chiefs, who are in their 7th year and are very knowledgeable. 

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Hours: 6am to ~5-6pm, with one day off (typically tuesday). 24 hour shift Friday (6a-7a), post-call Sunday. 

Pager: 5000

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Schedule/Workflow

Rounds start at 6AM M-F and at 7AM on weekends in the NCCU/NIMC conference room, and are lead by the chief neurosurgical resident. They start very promptly and WILL NOT wait for you, so be on time.

You do not have to preround (you can show up a few mins before 6).  Sign over the 5000 pager before rounds start. The on call person will have lists printed for everyone already.

You run through the list then see each patient, starting with the ICU. In the ICU, if patients are primarily on the neurology service, you'll examine them in front of the team (be quick - they're surgeons. Pupils, orientation questions, pronator drift, and leave, or the surgery people will abandon you and move on to the next patient).

The NuSu people will then go see all of their IMC/floor patients too, which you don't have to stay for. You'll touch base with the NCCU attending to see if there's anything they need you to do immediately, then you try to make it to morning report.

 

Around 9AM you generally begin rounding with the attending and one of the PAs. Before rounds, try to split up the ICU pt’s with the PA to decide who is writing notes on which patient. If it’s Dr. Kornbluth, he likes to review imaging. If not, then grab a COW.

 

During rounds in the NCCU the nurses present the patient (systems-based), and whoever is writing the note can work on their note while the other puts in the orders and pulls up labs/imaging/other results as needed. Make sure to put in the next day's AM labs for 5AM if they are not already in (there's an NCCU labs order set).  You can try to be judicious, but usually the NuSu poeple will just get a whole panel except for the coags regardless of whether it is necessary. If someone is intubated, get an AM CXR at 5AM, but it has to be taken by Pedi Radiology in the order in Soarian.

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After rounds, get your work/notes done. If a new non-NuSu patient needs admission during the day, you do it. If there’s a stroke code that is going to thrombectomy or getting tPA, you should definitely go with the consult resident because they’re coming to you anyway in most cases. 

 

You stay until sign out to whoever is coming on for the night, which generally takes place ~5-6 in the conference room. If things are slow and the person on call is out of the OR, sometimes they sign out as early as 3 or 4. They table round on everyone again (including the floor patients) and physically round on everyone as well. You're expected to stay through NCCU table rounds, and they prefer you to stay through all of table rounds and go see the NCCU patients so that if there's an exam change you can tell them (since you were there all day and the PA leaves after table rounds). Staying for physical rounds is optional, but the NuSu people appreciate it. 

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If something goes wrong with a NuSu patient that you don’t know what to do with, find a PA or page 4000. In either case always let them know what you did to their patient.

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Pro tip: one of the biggest challenges of this rotation is dealing with the NuSu people, since they consider the NCCU their territory. As long as you're working hard and being a good team member, things will go smoothly. 

 

Weekends

You have to do a 24h shift when you cover the 5000 beeper during the day, then also cover the neurology floor/consults (pagers 2038/6500) and stroke codes starting at 7p, and stay until you are done handoff in the morning. It's not usually as bad as it sounds.

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On Saturday morning, you'll sign out to the ICU people at 7 in the NCCU conference room.

Weekend signout rounds are at 7a instead of 6a, and if it's Dr. Cai there will be bagels!

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