Consult Night Float (CNF)

Last Updated: 6/2020

CONSULT NIGHT FLOAT

Brief Description:  
Consult night float is the rotation with the most responsibility as you (outside of the NICU fellow) are the most senior neurologist in house. You will be the face of our department, and many other doctors (including attendings!) will look to you for guidance on neurological issues.  Remember to be a professional and excellent representative from the Neurology Department

Schedule Highlights:  
Days: Sunday-Thursday
Hours: 7pm-9am
Weekday sick pull: No
Weekends/Holidays: No (except Sunday night)

Daily Schedule 

  • 7pm: Arrive in NI1, take stroke pager and sign into consult list
  • 7am: Last new consult
    • You also should see any urgent consults between 7am and 730am, but non-urgent may be saved for day team
  • 7:30am: Give pager to consult senior
  • 8am: Rounds (you must leave by 9am)

Stroke codes

  • We are hoping to continue doing some telestrokes in the ED for several reasons:
    • Cuts down door to needle time
    • Maintains a functioning telestroke system in the ED in the event of future pandemics or other crises that would require this system
    • Allow you to get training doing telestrokes, which many attending jobs require!
  • For 2020-2021 in particular, your class had limited experience with in-person strokes due to COVID, thus you should start the year doing in person stroke codes
  • However, the ED will always have the telestroke set-up ready
  • Whenever you feel comfortable, you should slowly start doing telestrokes from NI1 (feel free to discuss with the chief if you have any questions)
  • If you have technological issues or you are already in the ED seeing a patient when the pager goes off, you may always do an in-person stroke code
  • Jabber should be installed on all NI1 computers and is also on your phone, though EPIC may be converting to zoom *TBD if this includes telestroke
  • Cases must be staffed just like in-person tPA decisions
    • Fellow can join via telestroke if helpful

Staffing 

  • All consult must be staffed by attending within 24 hours of consult request
  • Any blood in the head must be discussed with the NICU Fellow
  • Overnight staffing
    • All consults being discharged MUST be staffed with attending
      • General: NYP on call attending
      • Stroke: Putnam Service attending
    • You may also call the attending with any clinical questions
    • If you believe a consult would benefit from an exam (either due to a question or for making a dispo decision, we are working to get the tele carts functioning in the ED so the attending can do an exam)
  • AM Rounds
    • 7am rounds with Dr. Lennihan
      • Not required but she is available to staff cases between 7-8am
      • The goal is to help get you out earlier!
      • Should prioritize cases that are pending discharge from the ED, those that you may be able to sign off on and those that need an urgent attending evaluation
      • Call her at 6am (do not text/email) if you have cases for her
    • General
      • Rounds start at 8am and you must leave by 9am
      • Prioritize staffing complex cases, that way if you run out of time CSr can read your notes for more straightforward case
    • Stroke
      • The stroke fellow should call you in the morning to hear about the cases
      • You are not expected to round with the stroke team
      • If the fellow has not called and you have new stroke consults, you must get a hold of them before you can leave for the morning

Admitting Patients

  • Floor and SDU
    • It is YOUR responsibility to signout any admissions to ANF and notify ED team of admission
  • NICU
    • Notify the fellow as soon as you know a patient will need NICU
    • They will help with bed assignment
    • It is your responsibility to monitor these patients (together with ED staff) until they physically move to the unit
    • The ED resident should transport the patient (if they ask I always explain that I am carrying the stroke pager and might get called away)
  • While the decision to admit to neurology is *almost always* ours, the ED attending may supersede your decision and admit to neurology
    • If this happens, you are welcome to involve the attending
    • Please also email the chief, as we discuss these cases in detail with ED staffing to determine why there was a difference of opinion

Requirements & Reminders

  • All patients must have a “Consult to Adult Neurology” order, if it has not been placed, ask the primary team to do so
  • All notes must be complete and co-signed to the correct attending
  • All recommendations should be clearly written in notes and communicated to the primary team
  • Signout: In addition to staffing with the attending, it is your responsibility to clearly sign out to the day team anything that needs to be followed up 
    • This can be done via columns in the EPIC lists – people have variable systems, just keep it consistent and make sure CNF/weekend residents know this system

Staffing

  • All consults must be staffed by attending within 24 hours of consult request
  • All consults planned for discharge MUST be staffed with the attending
    • General: NYP attending on call
    • Stroke: Stroke service attending
  • All stroke codes (not just tPA and thrombectomy candidates) must be staffed with the fellow (see Stroke Consult page for staffing schedule)

Tips

  • NYP on call and Putnam Stroke Service attending are ALWAYS available to discuss cases
    • NICU fellow is available to discuss emergent, urgent and ICU questions but other questions should go to attendings 
  • If you think there is a high probability that a patient will be discharged pending a test, you can call the attending earlier in the night to discuss your plan if the test shows what you predict, and contingency plans for other results 
  • If you are ever unable to reach the on call attendings, you can always call Dr. Lennihan or Chief Resident
  • Make sure all consults end up on the appropriate consult list!!
  • Remember to always communicate plans with primary team

Important Contact information:

  • Pagers
    • General Consult Pager 86876
    • Stroke fellow: 80021
  • EPIC role
    • Provider – no patient assigned
  • Epic Team (sign into both)
    • EPIC CUIMC Neuro Gen Consult Senior (CSr)
    • EPIC CUIMC Stroke Consult (SC)
  • MRI radiology supervisor  82736 (“82- REM”)
  • PPOC 697-7762 (697-PPOC)
  • Neuro Onc email: NeuroOncologyOps@lists.cumc.columbia.edu
  • Raven email: neuroravenclinic@columbia.edu
  • For general outpatient follow-ups, please refer to these guidelines