This will be a 1-4 week elective to help the senior resident gain experience with evaluating regional consult and transfer requests from the UW Access Center and the VA AOD triage. This elective will be primarily done during the daytime hours, in conjunction with the on-call attending physician. The resident will manage telephone consults with direct (real-time) supervision, and have the opportunity to observe video telestroke consultations.
By the end of this elective, the resident will gain proficiency in managing calls from providers who are requesting guidance on the evaluation and treatment of patients with potential cerebrovascular diseases. The resident will learn the limitations of not being able to directly interview and examine patients with acute neurological deficits. He or she will discuss cases with referring providers to obtain the necessary information regarding patients’ candidacy for IV thrombolysis, determination of more imaging should be done locally, and when it is necessary to transfer the patient to our hospital for a higher level of care.
Objectives and Evaluation Matrix
As with all of the fellowship rotations, the specific objectives are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the end-of-rotation evaluation.
|Upon completion of the curriculum, residents will . . .|
|1||Interact with the access center nurses and referring providers in a professional and clinically appropriate manner.||PR1, IC3|
|2||Help the referring providers in the decision to administer IV thrombolytics and/or obtain further imaging at the local hospital.||PC1, PC3, PC6, PC8, MK1, MK2|
|3||Help the referring provider determine if transfer to the UW/VA or other hospital is appropriate and what the best mode of transportation is. When transportation is necessary, the fellow will also adequately communicate any necessary information to the on-call team (residents, attending physicians) so the handoff is safe for the patient.||PC3, PC6, SP3, SP4, IC3, IC4|
|4||When performing a telestroke, the fellow will understand the advantages and limitations of using the video system for evaluating the patient and making recommendations.||PC6, MK2, SP3, SP4|
|5||When performing a telestroke, the fellow will adequately document the encounter and send note to the referring provider using the established templates in HealthLink.||IC3, IC4|
|Please grade the resident on any of the following milestones you were able to evaluate during this rotation:|
This will be coordinated with the on-call attending. Ideally it will be for most of the daytime call hours (8AM-8PM).
There are two optional working case conferences that may be of interest to fellows on the access call elective.
- Neurovascular conference occurs on the 2nd and 4th Mondays of each month at 1600 in the Juhl conference room, 4th floor near the Atrium elevators. It is an interdisciplinary working conference mostly involving complex aneurysm and AVM cases.
- Stroke Case Conference occurs on the 2nd and 4th Thursdays of each month at 1530 in the Neurology conference room (MFCB 7114). This is a working conference for complex inpatient and outpatient stroke cases, primarily involving neurology stroke faculty.
The number of work hours per week is estimated to be 50-60.
American stroke association guidelines: http://my.americanheart.org/professional/guidelines.jsp
Bogousslavsky, J., & Caplan, L. R. (2001). Uncommon causes of stroke. Cambridge, UK; New York, NY, USA: Cambridge University Press.
Mohr, J. P., Wolf, P. A., Grotta, J. C., Moskowitz, M. A., Mayberg, M., & von Kummer, R. (Eds.). (2011). Stroke pathophysiology, diagnosis, and management (5th ed.). Philadelphia, PA: Elsevier/Saunders.
Stroke Trials Registry. This website contains summaries of many completed and ongoing clinical trials. http://www.strokecenter.org/trials/
Latest revision: 05-14-2021