This is a hybrid rotation for interns in collaboration with the neurology residency. There are three inpatient services at CUH, all housed in the CUH-Zale system, on which interns will rotate. You will not be responsible for any night shifts. The CUH Stroke, CUH Gen Neuro, and CUH NCC service are all covered by a single neurology resident at night (the night float). At Parkland, our residents assist with care of neurology patients on the P Gen Neuro and P Stroke.
Goals and Objectives
- Develop an understanding of neurological disorders seen in the hospital
- PGY-1: Understand the basic principles of assessing and managing common presentations of neurological disease in hospitalized patients
- Competancy: Patient care, Medical knowledge
- Developing diagnosis skills
- PGY-1: Learn how to effectively use the bedside clinical examination in patients with common neurological disorders
- Competancy: Patient care, Medical knowledge
- Understand the differential diagnosis of common neurological disorders
- PGY-1: Develop a basic differential diagnosis for common clinical scenarios in patients with neurological disorders
- Competency: Medical knowledge
- Learn pharmacological management of common neurological disorders
- PGY-1: Learn the common medications utilized for the management of neurological disorders
- Competency: Medical knowledge
- Effectively consult on inpatients, develop, and execute assessment and management plans.
- PGY-1: Learn the steps required to be an effective neurology consultant. Recognize how to prioritize patient problems
- Competency: Patient care
- Effectively execute day-to-day management of patients
- PGY-1: Learn to manage neurology patients on a daily basis including a daily assessment and determining progress in clinical problems
- Competency: Patient care
- Interdisciplinary care and discharge planning
- PGY-1: Learn how to communicate effectively with the interdisciplinary care team and anticipate patient needs for discharge and effective follow-up
- Competency: Patient care, System-based practice
- Rational ordering of lab tests and imaging studies
- PGY-1: Learn the indications for basic laboratory investigations and imaging in patients with neurological disorders
- Competency: Practice-based learning and improvement, Medical knowledge
- Familiarity with the electronic health record and optimization of its use
- PGY-1: Develop a basic understanding of The EHR and its core components and how it can be used to care for patients with neurological disease
- Competency: Systems-based practice
- Communication and teamwork
- PGY-1: Recognize the core members of the patient care team involved in care of patients with neurological disorders, to include nurses, patient technicians, physical therapists, occupational therapists, discharge planners and hospital administration personnel
- Competency: Professionalism, Interpersonal and communication skills
CUH General Inpatient
When to report: 7am on the first Monday of block. (Weekly rotation is from Monday – Friday).
Where to report: Rounding room is CUH 8.1522 (in the Orange Tower right by staff elevator bay #3).
Hours: M-F, 7AM to sign out, approx 4PM ***Please note all Internal Medicine residents and preliminary interns (including neurology interns) rotating on Neurology services are excused to attend our Noon Conference***
Team structure: 1 senior neurology resident, 1 junior neurology resident, an off service resident, and attending
- This is predominantly a primary service that sees neurology primary patients that have non-stroke issues. Admissions are either directly from clinic, through the ER, or transfers from outside hospitals. There are also sometimes transfers to the floor from the neuroICU. There may occasionally be neurology consults patient admitted to this service at the discretion of the triaging resident.
CUH Stroke
When to report: 7am on the first Monday of block (Weekly rotation is from Monday – Friday). Please page the fellow on call (CUH – Stroke) the day before (Sunday) to better plan according to the census.
Where to report: 8.1619 (CUH Orange Tower, right off staff elevators #4)
Hours: meet the fellow at 7am in the rounding room each day and discuss which patients you will see. Try to pick up the new patients that were admitted overnight. Attending rounds are usually at 9am. From 7am to signout, you will take care of stroke patients and admit new stroke patients. When you are finished with your work for the day, sign out in person to the CUH general neurology team (usually around 5PM). Alternatively, if you are signing out past 7pm, you can sign out directly to the night float cross cover resident. Signout usually happens in the 8th floor general neurology room (see below).
***Please note all Internal Medicine residents and preliminary interns (including neurology interns) rotating on Neurology services are excused to attend our Noon Conference***
Team structure: 2-3 medical students, an intern, two NPs, a fellow, and an attending (no residents). Usually the fellow holds the code stroke pager.
- This is the primary admitting service (a.k.a. the neurovascular service) taking care of patients with strokes, TIAs, and other neurovascular diseases. It is also the consult service evaluating patients who are suspected to have strokes on other primary services at CUH·
- Before you enter orders on a patient, check to make sure you are the primary! As a rule, don’t enter orders on patients for whom your team is consulting, just leave your recs in your note.
- Code strokes are paged to the stroke team. In-house code strokes are taken care of by members of the stroke team. You should attend these with the team for learning purposes but will not be responsible for holding the stroke pager or running code strokes.
CUH Neurology Consults
When to report: 7am on the first Monday of block. (Weekly rotation is from Monday – Friday).
Where to report: Rounding room is CUH Orange Tower, 10.1517 (updated location)
Hours: M-F, 7AM to sign out, approx 4PM ***Please note all Internal Medicine residents and preliminary interns (including neurology interns) rotating on Neurology services are excused to attend our Noon Conference***
Team structure: 2 neurology residents, an off service resident, and attending
- This is predominantly a consult service that sees neurology consults on the floor and in the ICU where the questions are non-stroke related. There may occasionally be a primary neurology patient admitted to this service at the discretion of the triaging resident.
Neuro-Critical Care (CUH NCC)
When to report: 6am on the first Monday of block. (Weekly rotation is from Monday – Friday).
Where to report: CUH 3.702 (orange tower, right by the HUC and orange patient elevators)
Hours: M-F, 6AM-6PM ***Please note all Internal Medicine residents and preliminary interns (including neurology interns) rotating on Neurology services are excused to attend our Noon Conference***
Team structure: APP, interns, +/- neurosurgery resident, fellow, and attending
This service is primary on neurology patients needing ICU level care (status epilepticus, myasthenia gravis or Guillain Barre needing intubation or close respiratory monitoring, stroke patients who are post-thrombolysis or post-thrombectomy, etc.). This service also comanages neurosurgery patients who need ICU-level care.
Parkland General Neurology (P Neuro)
When to report: 7am of first Monday of block
Where to report: Parkland general neurology rounding room (16th floor, 400 side, proximal work room)
Hours: M-F, 7am to sign out (approx 3-6pm) ***Please note all Internal Medicine residents and preliminary interns (including neurology interns) rotating on Neurology services are excused to attend our Noon Conference***
Team structure: 1-2 off service interns (PMR/FM/Psych/IM), 2 neurology PGY-2s, 1 neurology PGY-4, attending
Work Flow:
- 7am: Arrive and divide new patients (admitted overnight or AM routines floor consults)
- 7am-9am: pre-round, discuss with senior, prep notes
- 9am: attending rounds
- Afternoon: finish work and see PM routine floor consults, sign out to short call resident, go home
How to prepare: review the neurological exam
Recommended tools: reflex hammer, tuning fork, safety pins, bright pen light, vision acuity card
Parkland Stroke (P Stroke)
When to report: 7am of first Monday of block
Where to report: 16 LRC (16.513)
Hours: M-F, 7am to sign out (approx 3-6pm) ***Please note all Internal Medicine residents and preliminary interns (including neurology interns) rotating on Neurology services are excused to attend our Noon Conference***
Team structure: 1-2 off service rotators (PMR/FM/IM), 2 neurology PGY-2, 1 neurology PGY-4, +/- stroke fellow, attending
Work Flow:
- 7am: Arrive and divide new patients (admitted overnight or AM routines floor consults), discuss with senior/fellow, prep notes
- 7am-9am: pre-round
- 9am: attending rounds
- Afternoon: finish work and see PM routine floor consults, sign out to short call resident, go home
How to prepare: review the neurological exam and NIHSS
Recommended tools: reflex hammer, tuning fork, pins, pen light, vision acuity card.