RAVEN clinic

2018-2019 Dates for RAVEN availability

2018

7/1-7/14 OPEN

7/15-7/28 CLOSED
7/29-8/11 OPEN

8/12-8/25 CLOSED

8/26-9/8 OPEN

9/9-9/22 CLOSED

9/23-10/6 OPEN

10/7-10/20 CLOSED

10/21-11/3 OPEN

11/4-11/17 CLOSED

11/18-12/1 OPEN

12/2-12/15 CLOSED
12/16-12/29 OPEN

12/30/18-1/12/19 CLOSED

2019

1/13-1/26 OPEN

1/27-2/9 CLOSED

2/10-2/23 OPEN

2/24-3/9 CLOSED

3/10-3/23 OPEN

3/24-4/6 CLOSED

4/7-4/20 OPEN

4/21-5/4 CLOSED

5/5-5/18 OPEN

5/19-6/1 CLOSED
6/2-6/15 OPEN

6/16-6/29 CLOSED

6/30 – OPEN

RAVEN clinic for minor stroke and TIA (NIHSS </= 5): Available Sunday after 8pm through Friday morning (excluding holidays) during the weeks above.

Email neuroravenclinic@columbia.edu to notify them that a patient is coming the following day.  Look at amion under the Clinic tab and find out which resident is in RAVEN the next day and cc them in the email. Include the following:

  • Patient name/MRN and (accurate, up to date) phone number
  • Brief one liner: “patient seen last night in ED for X. She will be seen following tomorrow morning [date] in RAVEN clinic for Dopplers, TCD.” Specific information provided as needed.
  • Then must copy and paste: “Resident must reply to this email, to confirm they received this email. TCDs and Dopplers needed to be ordered in Crown by attending, whoever will order please reply and confirm to this email”

Discharge Paperwork (to be given to the patient)Please fill in the date after printing!

RAVEN Patient Discharge – English

RAVEN spanish

Protocol:

Raven protocol

  • IF a patient is being discharged:
    • Add the .ravenconsult acronym expander to the end of your consult note
    • Either the consult resident OR ANF resident will review the diagnosis of TIA/minor stroke and stress the importance of follow up with the patient and give them the discharge handout (print above) with the correct date for follow up.
    • Attending will complete the RAVEN note and order dopplers in CROWN
    • Email the RAVEN group (see above)
  • IF a patient is being admitted:
    • Consult resident or ANF writes RAVEN note as a separate neurology free text note

RAVEN_SOP – Full protocol 

RAVEN Decision Tool (to be provided on laminated cards)

RAVEN DISCHARGE CRITERIA (print from here)

1. Disabling deficit present?
[ ] YES [ ] NO
Comment: The following mild deficits are generally considered disabling. Indicate which, if any, are present:
[ ] Complete hemianopsia (=2 on NIHSS question 3)
[ ] Severe aphasia (=2 on NIHSS question 9)
[ ] Visual or sensory extinction (=1 on NIHSS question 11)
[ ] New weakness limiting sustained effort against gravity (=2 NIHSS question 5 or 6)
[ ] New gait impairment
[ ] Symptoms that warrant inpatient physical or occupational therapy assessment
[ ] Dysphagia that warrants formal evaluation
[ ] Any deficit considered disabling in the view of the patient and treating practitioner.
Specify: ________________________
2. Head CT positive for intracerebral hemorrhage?
[ ] YES [ ] NO
Comment:
3. Patient treated with IV tPA for acute stroke?
[ ] YES [ ] NO
Comment:
4. Fluctuating or recurrent symptoms within past month
[ ] YES [ ] NO
Comment:
5. EKG shows new-onset atrial fibrillation or new MI
[ ] YES [ ] NO
Comment:
6. Carotid imaging within last month shows > 50% carotid stenosis on symptomatic side
[ ] YES [ ] NO
Comment:
7. Carotid imaging CANNOT be performed as outpatient <24 hours
[ ] YES [ ] NO
Comment:
8. Blood pressure persistently =180/110 or IV anti-hypertensive agents administered
[ ] YES [ ] NO
Comment:
9. Stroke/NICU fellow requests admission
[ ] YES [ ] NO
Provide reason and explanation:

DECISION TOOL:
If ANY “Yes” –> Admit patient to Neurology Stroke service

If ALL “No” –> Discharge patient from the ED

DISCHARGE PLAN:
1. Aspirin 81mg or alternative anti-thrombotic as appropriate at discretion of MD

2. Hemoglobin A1c and lipid panel added to labs

3. Outpatient follow-up at 8:30 AM [INSERT DATE] at RAVEN (Rapid Access Vascular Evaluation-Neurology) clinic. Patient verbalized understanding of need to attend RAVEN clinic appointment within 24 hours

4. Patient provided with instruction sheet and map depicting RAVEN location. Education provided regarding stroke symptoms and need for outpatient follow-up. Patient verbalized understanding of need to attend RAVEN clinic appointment.

5. Email sent regarding follow-up plan to neuroravenclinic@columbia.edu (include patient contact number, symptoms, expected date of appointment).

RAVEN CLINIC ADDRESS:
Neurological Institute
710 W. 168th Street
2nd Floor, Doppler Laboratory
212-305-8034