Clinical
Resources

Chiefs' Roles: Dylan Cohen: KCH chief, Scheduling chief (Residents Master and Call schedule at all 3 sites) Jonathan Solis: UHB chief, Education chief (Noon conference, Grand rounds, Research projects), Resident QI/PI Curriculum Yookyeong Baek: Maimonides chief, Clinic chief A column on the master schedule lists the coverage chief. The coverage chief will be reachable by phone at any time for emergencies. If the coverage chief is not reachable, please contact the other chiefs immediately. If you are calling out sick, you must notify the coverage chief and speak to them on the phone. For nonurgent issues, or urgent issues during work hours, please contact the appropriate chief based on the roles outlined above. For urgent issues after work hours, contact the coverage chief. For juniors: please escalate any immediate issues to your team seniors (to call for help from other hospitals, for triaging consults when on call, or similar issues), seniors will decide if they need to escalate to the chiefs. For non-emergent work-related queries, please avoid WhatsApp messages so that we can have that as an informal way of chatting with colleagues. Write an email based on our roles (if you are not sure, just CC all three chiefs) and chiefs will reply at the earliest, usually within a few hours. For call schedule switches between residents, please email the chief on call requesting permission for a switch, CC the resident you are switching with (who must confirm their agreement), and wait for confirmation from the chief on call.

KCH: Day Shift (7am - 4:30/5pm): see all consults placed by 4:15pm. If a non-urgent consult (ie. Parkinson's medication adjustment) is placed close to 4:15pm, ask the team if the patient can be seen the next day. Short Call (4:30pm - 8pm): maximum of 3 consults. If you already saw 3 consults and an emergent consult is placed (ie. status epilepticus, ICH, stroke code, cord compression), then you must see the urgent consult as well. Non-emergent consults placed after 7pm should be passed off to the NF resident. If it is emergent then you must see it even after 7pm. NF (8pm - 7am): Non-emergent consults placed after 6am should be passed off to the day team. If it is emergent then you must see it even after 6am. UHB: Day Shift (7am - 4pm): see all consults placed by 4pm. If a non-urgent consult (ie. Parkinson's medication adjustment) is placed close to 4pm, ask the team if the patient can be seen the next day. Short Call (4pm - 7pm): maximum of 2 consults. If you already saw 2 consults and an emergent consult is placed (ie. status epilepticus, ICH, stroke code, cord compression), then you must see the urgent consult as well. Do not see any non-emergent consults placed after 6pm, this consult should be passed on to the NF resident. If it is emergent then you must see it even after 6pm. NF (7pm - 7am): Non-emergent consults placed after 6am should be passed off to the day team. If it is emergent then you must see it even after 6am. Friday & Saturday 24hr call (7am - 7am) - do not see any new non-emergent consults after 6am.  If there is a late stroke code, then do the stroke code and quickly document your stroke note. However, the decision to admit and full evaluation including complete med rec, shx, fhx, etc can be done by the day team if you don't have time to do it before signout. Your priority is to ensure patient safety and leave the hospital after sign out at 7am. MMC: Same rules as UHB Some notes for nights: Check the list close to 6am to make sure there were no silent consults ordered, and if placed before 6am, you must see the consult even if the team did not page you. You must see ALL the neurology consults requested between 6pm - 6am. All communications with Stroke Team are through Webex, please download the app and follow-up on Stroke and NIR recommendations for your patients. You will staff neurology consults with the attending on-call, or the senior resident based on the schedule. For all neurology admissions and send-outs, recommendations should be discussed with the attending (even if there is a senior resident on call overnight). For admissions, you are responsible for writing the H&P - you can ask the PA to help with admission orders based on your recommendations, but you should help if they are busy. Currently the general neurology service is not responsible for EMU patients - these patients should be taken care of by the PA and EMU attending. In rare situations when there is no APP, you may have to cover the inpatients and EMU patients. In this case, assign yourself as first call for these patients. If you are consulted for a patient that sounds like it should be a neuroICU consult, you should still see the patient. Do not refuse to see a status epilepticus consult. If it is clearly neuroICU (patient in SE now intubated), you can discuss with Dr. Levin directly. Otherwise, you should discuss with the general neurology attending, and it is their decision whether to have you discuss with Dr. Levin.

If you are alone on short call or NF at KCH and receive a barrage of consults, you may need to call for help from the UHB resident. There is no strict rule for when you should call for help. The decision should be based on patient safety. If you feel you cannot safely see your consults in a timely manner, then immediately call the senior resident to discuss whether to call for help. The senior resident should make the decision and the senior resident should make the call for help themselves. For example, if you receive simultaneous stroke codes and during the codes the ED calls you for a cord compression case, you need help as you cannot possibly safely take care of all 3 patients at once. Generally, if there are 3 or more urgent consults pending you should consider calling for help. Sometimes, a couple consults can be pushed off to the next shift if non-urgent (ie. dementia evaluation).

This applies when medicine teams request neurology's help for LP, not for other services. We should always be courteous and try to help when we can. Primary team Primary hospitalist or any faculty hospitalist Chief Medicine Resident Neurology resident Neurology attending (if neurology resident in service is not credentialed) When Medicine residents call Neurology residents for supervising an LP on a medicine patient, they need to confirm that none of the medicine residents in service is credentialed, that their attending is not available to supervise, as well as their chiefs. If all those people have been contacted, then the neurology service has to supervise the procedure (in case the neurology resident is not credentialed, the neurology attending in service should be contacted).

If you are consulted for a pediatric patient, if they are in the pediatric ED, tell the ED team to consult pediatric neurology, even if the patient is ≥18 years old. You must respond to pediatric stroke codes. Perform the pediatric NIHSS (see MDCalc) and call the pediatric neurology attending on service. Do not take the patient to CT scan before discussing with the attending. Then let the pediatric neurology consult resident know as well.