ED Consults

The Emergency Department provides a steady stream of patients with neurologic symptoms, and accordingly a large number of Neurology resident consultations. These vary considerably in level of acuity, and the final disposition of the patients may be a discharge with urgent neurology clinic followup (within 1 to 2 weeks), observation in the ED, admission to another service with Neurology following as a consultant, or admission to the Neurology inpatient service. 

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The Tufts ED number is x5566

The Lahey ED number is x8100

The general lists of steps to take with an ED consultation are: ​

1. Receive the consultation request page. 

2. Call back the ED resident or attending requesting the consultation to hear the story. Clarify the question or reason for consultation (in a polite and courteous manner. Remember, they are asking for our help, even if they do not always express their concerns eloquently.). If appropriate, you can make initial recommendations or requests (for lab draws, obtaining orthostatic vital signs, etc.). 

3. If the patient is clearly of low acuity, then you can assign a medical student to see them, otherwise go evaluate the patient yourself

4. If you feel comfortable with your impression and plan after evaluating the patient, you may give your initial thoughts and basic recommendations to the ED resident or attending providing care for the patient. If you are not certain (or think that the plan may change after staffing with your senior resident or attending), then do not provide recommendations yet. Generally, it is not a good idea to predict the patient's disposition at this stage (especially if you think the patient might be admitted to the hospital, do not make the assumption that the patient will or will not be admitted to Neurology or another service). You may get pressure from the ED for disposition, but it is always okay to say "give me a few minutes to staff it, and I'll get back to you". 

5. Page or call the senior resident or the attending with whom you will be staffing to let them know that you would like to staff an ED consultation. In general, provide the patient's name, MRN, and presenting symptom, as well as your contact information (extension, pager, cell phone). 

6. Staff the patient. Be aware of whom you are staffing with: some seniors and attendings prefer more information, while others prefer less information. In general, be organized, clear, and concise. Most will ask you what YOU want to do, so try to take a stab at a diagnosis and  management plan. If they disagree, they will politely suggest an alternate plan and explain their reasoning. If they don't explain their reasoning, ask why! (You have to justify the reasoning to the ED and also write the note, so you need to understand.) 

7. Once you have an impression and plan formulated with your senior or attending, either call or find in person the consulting ED resident or attending to convey your recommendations. 

8. Add your patient to the consult list if the patient will be followed by a Neurology consult service. 

9. If you are admitting a patient, then: 

   1. Do the patients medication reconciliation and if possible do the admission orders

   2. If you are admitting the patient to a Neurology inpatient service, you should sign out the patient to the accepting Junior resident (or to the on-call Junior resident or Night Float during the evening).

   3. If you are admitting the patient to the Neurology ICU, you will need to staff the patient with the appropriate Neurology ICU attending, sign out the patient to the covering Neurology or Neurosurgery resident. 

   4. Add your patient's information to the Signout in the charting section of Sorian. 

   5. Write your consultation note

   6. Followup on any studies performed in the ED for your patient while you are covering the pager. You are not required to return to the ED to counsel or update patients and their families, but you may if you wish and have time. Otherwise, the ED is the primary team and can communicate our recommendations; they usually understand that we are busy. If there are pending studies by the time your shift is over, sign out these pending studies and pending dispositions to the next resident. If the patient needs to receive specific medications, please make sure that both the next resident and the ED team are aware of these medications (e.g. scheduled anticonvulsants, antiplatelet agents, heparin infusion, etc.).