Neuro-oncology

Neuro-oncology

Neuro-oncology Inpatient Care 7.10.2018

During your rotation on Neuro-oncology you will be responsible for overseeing the Neuro-onc list and seeing new and follow-up consults.  You will also spend three ½ days per week in the Neuro-onc clinic. Neuro-onc consults are performed for patients who have questions directly related to neuro-oncological diagnosis (including occasional LPs for possible lepto, surgery) and treatment (surgery, chemo, and RT).

 

General Logistics

  • Please review the document posted above from Dr. Lassman (Division chief) for criteria for a Neuro-onc consult (versus general or stroke). Many new consults may not need to be seen inpatient (especially those without pathology back, with the EXCEPTION of high-likelihood lymphoma).  If you have questions, you can ask the inpatient attending.
  • Email is KEY on this rotation — if you do not have your Columbia email on your phone right now, you must change that. It is the primary way in which the attendings will communicate with you; in some cases they use email the way you might text. It is not uncommon for them to email about follow up appointments or new patients they want you to see that day (or that they want to meet you to round in 15 minutes).
  • If you hear about a patient pending biopsy, send the name and service of the patient to the “Inpatient attending” and ask if consultation can be deferred to the outpatient setting once path is back. CC Liz Calderone, who makes appts for new patients. The exception to this is 1) patients for whom primary attending wants inpatient consult, and 2) tumors with high suspicion for CNS lymphoma, in which case treatment is usually started same admission.
  • When you hear about a new patient, add to “_Neuro Oncology Service” list on Eclypsis.
  • Use the “Neurology Oncology Note” for these patients, and the neuro-onc templates for initial and follow-up visits.
  • All patients that are being seen for the first time in the hospital require an “initial” note, regardless of whether they are known to the Neuro-onc clinic.
  • When seeing patients in Neuro-onc clinic, make sure that patient gets vitals (including height and weight!). If the MA is not there, it is your responsibility to do this.
  • Login to the NOnc dynamic role on mobile heart beat and instruct teams/ED they can contact you that way instead of the pager.
  • If you hear a patient is leaving, ask attending when they should follow-up and email Stephanie Ivanoff to schedule follow-up patients.

 

 

Schedule

  • At the beginning of the rotation, you will receive an email from Hannah Cox-Peralta (the Neuro-onc Coordinator) about your specific schedule for the week.
  • Hours are ~8 AM-7 PM. You will be in Neuro-onc clinic Monday, Tuesday, and Friday mornings. If your schedule indicates otherwise, please confirm with Dr. Kreisl.
  • Conferences
    • Metastatic Tumor Board – 4 PM in NI-9 conference room
    • Primary Tumor Board – 9:15 AM in Radiology conference room (1st floor of PH building in the Radiology Suite)
    • Neuro-oncology seminar every other week, 12-1 PM in NI-1 conference room (Rm 14 near callroom)
  • The ‘Inpatient attending” listed on your schedule will see new consults (and their follow-ups) at the time listed on your schedule.
  • In the morning, chart review the patients on the list (including labs, overnight events, and overall course). If you think that the patient should be seen that day for follow-up, email the attendings to see if they agree that patient should be seen. It is usually easier to email each attending a list of the follow-up patients that should be seen. Once confirmed that the attending wants to see those patients, you should see prior to the agreed upon time of rounding (different times for different attendings).  You will probably not see every follow-up patient, every day. Iwamoto rounds on Monday and Thursday at 1pm on follow-ups.