The Team 

VA Roles and Responsibilities

The Schedule

Outpatient Clinic


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


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.


Call

Call is from home, and averages q3 over the month. Call is normally pretty laid back. It's fairly uncommon to have to come in, but it does happen (roughly 1 in 3 nights on average over the month).

STROKE

1)      For daytime acute strokes at the VA, you CAN call the Brain Injury Group attending IF you want to discuss case, but it is NOT required to call them (provided you discuss the case with your VA attending). 

2)      All stroke patients (even subacute stroke admits) need an initial NIHSS documented within 24 hours.

3)      All stroke patients need a dysphagia screen documented before administering anything PO.  This is generally done by nurses in the ED, but MUST be documented.

4)      Please document that tPA was considered and (if applicable) why it was not administered.

5)      Patients receiving TPA should first be admitted to MICU (likely under MICU care with neuro consulting, though this is negotiable) for close neuro checks/monitoring; once stable, they can be transferred to general neurology floor.

6)      Stroke order set is located under Orders > Medicine Menu > Guideline Menus > Stroke

EEGs


The Residents Room

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.

Parking

VA Computers

The VA uses the CPRS system for writing notes and electronic order entry.

 Access CPRS from home (PC):

1. Download VPN

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

Basically, you have to get permission first (takes a few days for approval, can only apply for approval via a computer AT the actual VA), THEN install an additional app on your computer. Of note, if you don't have access at a time when orders are needed, nursing MAY accept verbal orders at the time if you ask nicely.

VA Notes and Encounter Forms

VA Outpatient Clinic Orders

      ¿  Step 1: Click on provider tab next to patient's name in CPRS

      ¿  Step 2: Change the provider from yourself to the staffing physician.

      ¿  Step 3: Write orders.

      *** This ensures that the results will be forwarded to the appropriate attending physician so that results are not lost when residents rotate off the VA.

VA Outpatient Clinic Misc

VA Tools

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.

VA Pharmacy issues

The VA pharmacy can get medications from other hospitals (UMHS or St. Joes) within a few hours if they are not at the VA. Keep this in mind if you desperately need something that is not in stock.