Stroke Inpatient

Introduction

This is a week-long rotation on the inpatient stroke service at the UW Hospital and the William S. Middleton Memorial VA Hospital. Residents mostly rotate on this service during their PGY-2 and PGY-3 years. The rotation emphasizes inpatient care of acute stroke patients.

The inpatient stroke team consists of an attending vascular neurologist, the neurology resident, an advanced practice provider, one or two medical students, and at times the stroke program administrative coordinator. Occasionally there is a neurosurgery or other off-service intern or an off-service resident pursuing an elective rotation. Pharmacy interns and other observers sometimes rotate on the service as well.

Following are the goals and objectives of this rotation as they relate to the overall training program in neurology and the ACGME-defined competencies. Please refer to the separate stroke service orientation manual for more comprehensive and specific information about the UW Comprehensive Stroke Center and the acute care of stroke patients.

This is an accordion element with a series of buttons that open and close related content panels.

Goals

PGY-2 Residents: The goal of this rotation for junior residents to develop competence in the inpatient management of stroke patients, with a focus on ascertainment of the stroke mechanism (etiology) and the secondary prevention strategies that follow. Residents will learn how to admit, care for, and discharge such patients as a member of an interprofessional team.

PGY-3-4 Residents: Senior residents will become more adept in identifying and managing uncommon causes of stroke and in leading the interprofessional team. They will advance their skills in neuro-imaging, especially multi-modal CT and MRI.

Objectives and Evaluation Matrix

As with all of the neurology 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. (Please see the section End-of-Rotation Evaluations for the list of milestone abbreviations).

 

Rotation Objectives
Upon completion of the curriculum, resident will…

#DescriptionMilestones
1Manage inpatients with cerebrovascular disease according to current evidence and guidelinesPC3, PC5, MK2, PL1
2Appropriately select and interpret neuroimaging studiesPC8
3Lead morning interdisciplinary rounds, interacting respectfully with the other team members while advocating for appropriate patient careSP3, SP4, PR1, PR2, IC3, IC4
4Lead family meetings regarding goals of care and negotiate conflicts among family members and the treatment teamSP4, PR1, IC1, IC2
5Discharge patients in a manner that ensures smooth transitions from inpatient to outpatient careSP3, SP4, PR2, IC3, IC4

Schedule

The stroke inpatient resident works Sunday – Friday. During the week, the resident receives sign-out from the night float resident around 7 – 7:30 am and pre-rounds on service patients. Interdisciplinary rounds begin at 0900 each weekday except for Wednesdays, when (for historical reasons) they begin at 0930. Teaching rounds follow thereafter, usually ending between 1100 and 1200, depending on service volume.

The stroke attending and APP cover the service from 1200 – 1300 so that the resident can attend didactic conferences. After rounds and conference, the resident will write notes and enter orders on current patients. At 4:00 pm, the night float receives signout for cross-coverage of the service’s patients.

On Sundays, the Stroke service resident receives sign-out from the night float at ~ 0730 and  rounds with the attending on the team patients at 0800. The stroke service resident then shares call, splitting the new consults with that week’s day float resident until 1800, at which time the night float takes over.

Saturday is the service resident’s day off.

Optional Conferences:

There are two optional working case conferences that may be of interest to residents on the Stroke service:

  • 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.

Work Hours

The number of work hours per week is estimated to be 60-70. Residents will have at least one day off each week, free from any and all clinical responsibilities.

The resident will be responsible for tracking work hours and reporting any risk of violation immediately to their attending physician and/or the program director.

Suggested References

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:  09-14-2024