Consult Night Float

Welcome to CNF!

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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 take consults from 7pm until 6:30am and urgent consults until the day team comes in at 7:30am except Sunday when you come in at 6pm. It is staffed Sunday through Thursday nights.

On Monday, Wednesday, and Friday mornings, you will present any overnight admissions to the morning consult attending. Tuesday and Thursday you will sign out any overnight consults to the consult senior who will present them after radiology rounds/morning report (respectively).

 Here are some rules for staffing: 

  1. All consults discharged from the ED need tobe staffed. There is a new rule this year and this applies to stroke codes as well! Stroke codes being discharged from the ED should be staffed with the stroke attending on call (whoever is on service. I’m working on adding this into amion, but for now you can find it if you log into amion under “vascularneuro”).

  1. If you staff a stroke patient with the NICU fellow overnight that gets admitted (or is already on) another service, PLEASE make sure you add them tothe stroke list and tell the stroke fellow about them the following morning.

  1. The NICU fellow is in house tohelp with stroke codes, emergencies, and if questions arise. However, if you find yourself asking them many (non-ICU level) questions about a patient, it’s probably best tojust wake the consult attending up and ask them what they recommend. They do not see patients so cannot be responsible for major management decisions — unless they are decisions that are directly related to a patient you would otherwise have in the NICU but can’t because there are no beds (i.e.: Herniation, status epilepticus).

I have never had a consult attending get upset that I called overnight – so if you have questions, that’s why they’re there.

Just some general tips:

Don’t forget to put patients on the list!

If you ever get stuck and cannot reach the NYP attending on call you can always call Dr. Lennihan (or me). Good luck!

Be careful blocking consults or deferring consults to the morning. If they really are non-urgent and you’re busy, that’s totally reasonable, but otherwise you should see them.

RAVEN clinic is active and runs from Sunday night through Thursday night.  

ALL DISCHARGES (including strokes) need to be staffed with an attending, including stroke codes. If it is definitely not a stroke, you can staff with the NYP attending on call – but if it is a TIA OR you are recommending imaging to rule out stroke, it should be staffed with the stroke attending (amion.com: “vascularneuro”). On Wednesday nights, the stroke attending who starts on Thursday is on call after 5pm.

Getting an MRI for dispo in the ED needs to be discussed with an attending first. These patients do not need tobe admitted for MRI, but we’re really trying to cut back on the number of MRIs we do to triage admit vs. discharge.

Billy Roth, MD

Chief Resident

Department of Neurology

Columbia University Medical Center