This is a hybrid rotation for interns in collaboration with the neurology residency. There are three inpatient services, all housed in the CUH-Zale system, on which interns will rotate. In addition, interns will work in the Parkland Neurology clinic. You will not be responsible for any night shifts. The Zale Stroke, Zale Gen Neuro, and CUH Consult service are all covered by a single neurology resident at night (the night float).

Zale Stroke

When to report: 7am on the first SUNDAY of block (Weekly rotation is from Sunday-Thursday, with Friday off). Please page the fellow on call (Zale -Stroke in AMCOM) the day before (Saturday) to better plan according to the census (i.e. if small, you might also get Sunday off). 

Where to report: 8.1619 (CUH Orange Wing)

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 Zale general neurology team. 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 3rd floor rounding room (see below)

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 both at Zale and 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.
  • If a code stroke is called at Zale, then the stroke service will go evaluate that patient. If a code stroke is called at CUH, both the CUH general neurology consult service and the Zale stroke service are notified (sometimes the CUH gen neuro service gets the page and has to notify the Zale stroke service). Whoever reaches the patient first should begin the evaluation, but if the patient ends up being admitted for a stroke they go to the Zale stroke service.

Zale General Neurology

When to report: 7am on the first Monday of block

Where to report: Rounding room is MOVED to CUH 8.1522 (orange wing elevator). 

Hours: Meet the residents at 7:00am in the rounding room to discuss which patients you will take care of each day. Rounds are usually at 8:00 or 9:00 depending on the attending. From 7:00am to signout you will take care of general neurology patients at Zale. The stroke service may sign out to you, at which point you will be responsible for their patients as well. At that point you may also be required to admit a stroke patient. Alternatively, the stroke team may sign out directly to the night float resident at 7pm. Your residents may dismiss you early. If not, you can sign out to the night float resident at 7pm. If the stroke team has signed out to you by this point, don’t forget to sign out their patients to the night float as well!

Team structure: an intern, two residents, adn an attending

  • This is the primary admitting service taking care of general neurology patients at Zale. It is also the consult service evaluating other patients with suspected neurological problems at Zale, and the cross-covering service for the stroke team after they sign out. You will not see consults at CUH on this service, since there is a separate consult service for that.

CUH General Neurology

When to report: 7:00am on the first Monday of block

Where to report: Round room has temporarily moved to 10.117

Hours: Meet the residents at 7:30am in the rounding room to discuss which patients you will see. Rounds are usually at 9:00 am but can vary by attending. From 7:30am to signout you will be consulting on inpatients at CUH. Signout happens at 7pm in Zale in the 3rd floor rounding room (see above). Your residents may dismiss you early; otherwise, you can sign out at 7pm to the night float resident.

Team structure: an intern, two residents, and an attending

  • This is the consult service covering neurology consults at Clements. This is not a primary service. If a code stroke happens at CUH, both the CUH Gen Neuro and the Zale Stroke team should be notified. Sometimes the CUH gen neuro team has to notify the Zale stroke team. Whichever team reaches the patient first should begin the evaluation. In addition, the CUH Gen Neuro consult service covers all neurology consults at Clements.

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)

Team structure: 1-2 off service interns (PMR/FM/Psych/IM), 2 neurology PGY-2s, 1 neurology PGY-4

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)

Team structure: 1-2 off service rotators (PMR/FM/IM), 2 neurology PGY-2, 1 neurology PGY-4, +/- stroke fellow

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.

Parkland Neurology Clinic

PMH Neurology Clinic (P Neuro)

Additional information

  • Check Amion for your days off. You may be EIOC during one of your Neuro Hybrid weeks. You will be notified by one of your chiefs if you get called to cover someone. The Neuro services are aware of this possibility, but it’s still polite to notify them if you can’t make it.
  • The Zale Stroke and Zale Gen Neuro services may take care of patients who require intensive care. These patients are housed in the Zale ICU, which is on the 3rd floor. The Neuro-Critical Care team helps take care of these patients as consultants (i.e. manage the ventilator, pressors, antihypertensive drips, intracranial pressure issues, etc) – you will still be the primary in these cases.
  • At Zale, the Epic system is connected with CUH, so you’ll be signing in as though you were at CUH.
  • If you are on Zale Stroke or Zale Gen Neuro, you will likely have to consult other specialties – e.g. cardiology for a patient in atrial fibrillation. Sometimes the specialty you’re consulting is at Parkland, and sometimes it’s at Clements. This can be confusing. If it’s not clear from the on-call paging system, just page the specialty either at Parkland or CUH and ask if they are covering Zale.
  • There is an Afternoon Report held Monday through Thursday at 4:30pm. This is a case conference during which a resident will present a case for the team to work through together. The Zale General Neurology service is expected to attend, along with a few services from Parkland. Ask your residents where the conference is held. You will be expected to attend noon conference with the Internal Medicine residency. If you’re at Zale, you can attend Parkland’s IM noon conference. If you’re at CUH, you can attend IM noon conference there.