Consult Staffing

By popular demand, please find below a centralized list of who to staff with when!!

GENERAL CONSULTS

  • 7 days a week: 8am-5pm: Consult attending
    • If there is an AM attending, they should staff all overnights and new patients that are ready to present before noon conference
    • PM consult attendings should see any new consults that are ready to staff before ~5pm
  • 7 days a week 5pm-8am: NYP attending-on-call
    • If they do not pick up despite several attempts, please contact the chief resident and/or Dr. Lennihan

STROKE CODES

  • Weekdays 7:30am-5:30pm: Stroke fellow
    • Except Wednesday 1-5pm, then call stroke consult attending
  • Weekdays 5:30pm-7:30am: NICU fellow
  • Sat 7:30am-3:00pm: Stroke service attending
  • Sat 3pm-7:30am: NICU fellow
  • Sun 7:30am-3pm: Stroke fellow
  • Sun 3pm-7:30am: NICU fellow

STROKE CONSULTS

  • Weekdays 8am-5pm Stroke Consult attending
  • Weekdays 5pm-8am: Stroke Service attending
  • Sat/Sun 24h: Stroke Service attending
    • Note: They switch Sunday at 5pm, so just check the time before you staff
    • Example below – Sunday after 5pm consults should go to Dr. Naqvi

SPECIAL CIRCUMSTANCES

  • For cardiac arrest consults, these should now be staffed with the general consult attending on service (NOT the NICU attending) – if the attending is not comfortable, contact the chief resident and we can discuss other options
  • For other subspecialties, feel free to contact the “Doc of the day” for that division (posted in amion)
  • They can answer curbsides and for some specialties will also do formal consults as needed
  • Any request for transfer to neurology (from other services or from the CPEP) should be staffed with the consult attending before accepting

NEURO-ONCOLOGY CONSULTS

Neuro-oncology questions and consults are often triaged through General Consults. When a consult comes in, the consult senior should ask the primary team what the specific consult question is and follow the guidelines below. 

The following consults should always be seen by the general consult team

  • ALL Patients in the ED. This includes patients with newly discovered brain masses, patients known to neuro-oncology who will be admitted to a neurology service for any reason, and patients known to neuro-oncology being admitted to a non-neurology service with an active neurologic issue or question
  • Patients where the question is not directly related to neuro-oncology (examples)
    • Brain tumor patient on medicine with seizures, question of AED management
    • Patient with peripheral neuropathy
    • For patients on malignant heme and med-onc, clarify who they want to see the patient
    • If there is a question of who should see the patient, can discuss with the neuro-oncology attending
  • Patients with newly discovered brain masses
    • Can discuss these cases with neuro-oncology attending to clarify which team should see

When there is a neuro-oncology resident/fellow on service:

  • They should see all consults excluding those outlined above
  • If there is an urgent question overnight, the CNF resident should see this patient
    • The general consult resident should write a full note if they evaluate the patient and make urgent imaging recommendations or direct the management of the patient (ie. patients with seizures)
    • The general consult resident can write a brief event note if they evaluate the patient to document the exam and do not feel further urgent workup is indicated. They must they communicate with the neuro-oncology team in the morning

When there is no neuro-oncology resident on service (including all weekends)

  • All consults for neuro-oncology patients (on any service and with any question) should be seen by the general consult team with the following exception
    • If a consult is non-urgent (i.e. patient admitted with a medical concern and imaging shows progression of disease without active symptoms) and the primary team is comfortable, you may defer until neuro-oncology is available (only acceptable if they will be on service soon, i.e. Sunday afternoon consult, they can see Monday)
  • If the consult question is related to oncology matters, you may reach out to the neuro-oncology attending to see if they can staff based on the following schedule:
    • Monday: Dr. Donovan (PM)
    • Tuesday: Dr. Pan (PM)
    • Wednesday: Dr. Donovan (PM)
    • Thursday: Dr. Pan (for now should try to staff with Dr. Pan in the morning before clinic, though can also be staffed Friday)
    • Friday: Dr. Pan 
  • Non-oncology questions and weekend consults should always be staffed with the general consult attending

NEUROIMMUNOLOGY CONSULTS

  • If you have a complex neuro-immunology patient that you would like subspecialty input on, reach out to the neuro-immunology fellow (under doc-on-call) in amion
  • They can answer curbside questions or do formal consults M-F (which are staffed within 24h by the neuro-immunology attending) 
  • For urgent questions over the weekend, you may reach out directly to the neuro-immunology attending on call (again under doc-on-call)
  • CAR-T cell patients
    • It is a good idea to let the fellow know about these patients (though they are often aware ahead of time)
    • If there is a new consult for a CAR-T cell patient over the weekend, it should be formally staffed with the general consult attending, but you can always discuss management with the attending-on-call