Notice! Confluence will be undergoing system maintenance on Mondays from 5pm to 7pm. During this time the system may be unavailable.

Versions Compared

Key

  • This line was added.
  • This line was removed.
  • Formatting was changed.

...


The Team

  • a senior neuro resident
  • a junior neuro resident
  • a psychiatry intern
  • med students (usually 2-4)

...

  • Arrive by 7:30 AM to clinic, which is in the Liberty Building by the Central elevators, Specialty Clinic C (floor 1, station 15) on Monday, Tuesday, and Thursday. On Fridays, the clinic is in Specialty Clinic D (floor 1 station 14)
  • As patients come in and are roomed by MAs, their sheets will be placed in the team room.  Grab them on first-come, first-serve basis and put your initials on the sign in sheet so we know who is seeing whomLynne (RN Care Manger) and senior resident will help distribute patients. Spend a few minutes reading up on story, then see them and staff with an available attending (proritize having RVs seen by attending who saw last time, and if possible have NPs seen by attending whose specialty it is, i.e. stroke patients seen by stroke attending, etc.)
  • Med students new to the rotation should shadow with resident for the first patient in any given clinic; after that, they can see RVs on their own and staff alone with attending, and write notes/orders for attendings to sign. Usually med students can see 2-3 patients per half-day.  Med student notes should be written initially with the med student as the author, but then the author should be switched to the attending (rather than as co-signer).

Monday

Tuesday

Thursday

Friday

Michael Wang – Stroke

Brian Callaghan – Neuromuscular

Tiffany Braley – MS

Vikas Kotagal – cognitive

Jack Parent – Epilepsy

Bill Stacey – Epilepsy

Andy Romeo – MS

Nico Bohnen – cognitive

Jim Burke - Stroke

Peter Todd – Movement

Dan Leventhal - Movement



Dustin Nowacek – ALS

Kevin Kerber – Dizziness/Movement


Consults

  • Daytime Consults: 8:00 AM - 5:00 PM; this time range is flexible within reason
    • Consults are paged to the senior resident from the requesting service. A consult order must be placed by primary team for you to write a consult note; if one not submitted, just enter the consult order yourself.
    • Consults are divided up by the senior resident (between senior, junior, and psych intern) and staffed with the inpatient attending; med students should see consults/follow inpatients and can write a note, but the patient should still be seen by the resident, and the resident needs to be the one to submit the final note. 
    • The senior (or junior if the senior is in clinic) should contact the attending to determine a rounding time.
    • Outside VA phone consults and transfer requests will be called to the VA senior by the AOD to review; discuss with attending prior to giving final recs.
    • If ER consult comes in during clinic, it is expected that a resident will break off from clinic to see the patient, and staff with one of the clinic attendings, NOT the inpatient attending. If a floor consult comes in, if not emergent then it can wait until the afternoon and be staffed with the inpatient attending per usual.
  • Afterhours After hours Consults (5:00 PM - 8:00 AM on weekdays, and all day on the weekends and holidays)
    • All afterhours after hours consults are paged to the resident on call.
    • Afterhours After hours consults are staffed by phone with the on-call attending.
  • The on-call attending list schedule is usually posted in the residents room.
  • The on-call list can also be found at:
    1. Go to http://vaww.ann-arbor.med.va.gov:1030/default.asp
    2. Hover over the "Service Schedules" drop down menu at the top of the page.
    3. Select "Neurology"
    4. Open the file for the appropriate month.
  • included in reminder email at beginning of the month
  • On call attending is also listed on MM paging website 


Inpatient Service

The service is usually on the small side, i.e. 2 or less. The psychiatry intern/junior neuro resident pre-rounds on any neurology inpatients, and handles their cross-cover, orders, and notes. Inpatients are generally individuals with fairly low acuity and stable neurological conditions. Any patient with multiple or unstable problems should be on a service that has in house coverage (usually medicine). If a patient would have been on the neurology service, but due to their other issues goes to another service, then it's good form to follow the patient as a consultant. The exact arrangements should always be discussed with the on-call attending first when staffing the consult / admission.

...

The neurology residents room is on the 4th floor. It's home base during the afternoons. It is in the offices right across from the Central elevators.   The key is in a lockbox next to the resident room, code 734; PUT THE KEY BACK WHEN YOU ARE DONE WITH IT. The key opens both the resident room, the MA room, and the EEG-reading room.

Streaming UMHS Noon Conferences through Adobe Connect

https://connect.umms.med.umich.edu/neuroconf/

Then you can login as a guest with your name. Write a comment and let them know you are there so someone can sign you in for conference.

Parking

  • Blue parking is available in the lot on the north side of Fuller (i.e. across the street from the front of the VA). The parking garage and the lots next to the VA are not for residents. On the weekends, you can park in the lot on the south side of Fuller. Overnight, you can park in front of the ER (at the back of the hospital) too if you are called in for consults.
  •  Talk to security to get a special passcard that opens the door near the auditorium in the front of the hospital, making for easier access in the mornings and after-hours.

...

 Access CPRS from home (PC):

1. Download VPN

2.Go here for further instructions:  http://www.med.umich.edu/i/clinical/cprs1.html

...

VA Tips for med students and psych residents

-Med student tips

Psych intern tips

Ordering IVIG at the VA:

1)  Go to "Templates," -> "Shared Templates," --> "Hematology/Oncology," --> "Legacy One-Prescriber Chemo Orders Notes," -> "IVIG"
2)  It then asks you to create a note.  I have not received clear instructions on what note to select, but chose "Neurology Inpatient"
3)  Fill in all prompts, including daily dose and number of cycles.  Remember that IVIG is usually dosed based on the Ideal Body Weight (unless the patient is cachetic).  There are calculators online.
4)  Do NOT forget to consent the patient using the software provided by AAVA.  If you fail to do this, you'll likely get paged to come in prior to administration of the IVIG (which chances are will be between 3-5am, just because that's when pharmacy will get around to sending the dose to the floor!)
   - To consent, make sure the computer is hooked up to an electronic signature pad then:  On the top of your patient's chart, click "Tools" then "I-MedConsent" (the 3rd option from the top).  A separate browser will open, that hopefully is linked to the patient chart.  If this fails to sync, you may have to close all programs and log back in.
   - Find the neurology procedures on the left, and select the correct procedure.
   - Go through all prompts, which you should read to the patient when they are with regards to risks.  Eventually you will get to where you first will place your signature.  Then the patient will be asked to place theirs.
   - Continue until complete.

...