Both in the clinic and the wards, neurology and child neurology are very much interprofessional disciplines. Nurses, physical therapists, occupational therapists, speech/language pathologists, neuro- and health psychologists, dieticians, respiratory therapists, social workers, and case managers all play crucial roles in our patients’ care. Importantly, optimal patient care depends not just on having members of these various disciplines independently performing their evaluations and treatments, but on actual collaboration among the team members; this is what is meant by the term “interprofessional”. The sine qua non of an interprofessional team is communication; in our residency programs, interprofessional communications occur constantly throughout the work day. During the adult neurology training year they formally occur at the following times:
- Morning interdisciplinary rounds—daily at 0900. The stroke and general neurology inpatient teams gather with the nursing staff, PT, OT, speech, swallow, social work, case management, etc. to discuss each patient on service with specific attention to their overall plan of care and anticipated discharge needs.
- Afternoon sign-out / interdisciplinary rounds—daily at ~ 1600.
Roles and Responsibilities of the Rounding Team Members- Adult Neurology Rotations
- Provide the highest quality patient and family centered care
- Treat patients, families, colleagues, and staff with respect
- Take ownership of your patients
- Promptly complete necessary documentation. (The provider discharging the patient is responsible for completing the discharge summary).
- Documentation, including the documentation of the exam, should not be cut and pasted.
- Medications and past medical history should be elicited from the patient and documented in the H&P
- If there is OSH data, it should be reviewed.
- Most of our inpatients need non-neurologic examinations (e.g. cardiac, abdominal, etc.) in addition to a neurologic exam
- Personally review imaging studies
- Maintain/update the sign out list
- Maintain your role in the Provider Team function
- Participate in morning multidisciplinary rounds
- Check in with the D6/4 lead nurse daily: in the afternoon on weekdays and at some point on weekends
- Facilitate open lines of communication about patient assignments, days off, etc.
- Sign pager out when unavailable
- Leader of the team.
- Know all of the patients on the team.
- Work with the intern and APP to determine which provider is following which patients.
- Answer questions from the interns and APPs and if the answer isn’t known, discuss with the attending.
- Run the list with the team members at least daily
- Respond to stroke codes
- Attend didactic session, as able.
- Inform the team about admissions (ED, consult, and OSH)
- Sign out the service to short call
- Teach medical students
- Know the patients you are caring for.
- Attend didactic sessions, as able.
- Review discharge summaries and discharge orders with resident or APP
- Know the patients you are caring for and have some familiarity with all the patients on the team.
- Carry a patient load that can be safely managed.
- Cross cover other patients on the service when the resident is unavailable (e.g. stroke code, clinic, VA).
- Attend didactic sessions, if interested.
- If your service is slow, offer to help other services
- Be present for end of the day signout
- Communicate days off and weekend coverage with the team
- Day off should not be when the resident on the team is in clinic
- If possible, only one inpatient APP should be off per day
- Work 40 hours per week
- Bill independently when there is no-to-minimal faculty input and bill as a shared visit when there is shared decision-making (substantive portion of the E/M visit is performed by the APP and physician on the same day).
Roles and Responsibilities of the Rounding Team Members- Child Neurology Rotations
- See above comments in “Adult Neurology Rotations” excluding points relating to D6/4 and multidisciplinary rounds.
Child Neurology and Adult Neurology residents:
- Lead the team of medical students, APPs and other learners.
- When child neurology resident and adult neurology resident are simultaneously both on the team the child neurology resident will function in a senior/fellow role.
- Know all of the patients on service, even those that are not being actively followed.
- Keep up to date on the EEGs running on inpatients with continuous EEG.
- Review and interpret all neuroimaging studies relevant to the patients on service.
- Actively communicate recommendations with primary teams ensuring closed loop communication.
- Teach the medical students, observe their neurologic examinations, provide access to the HealthLink patient list, and assign them to patients on service to follow.
- Attend required didactic sessions
- Provide sign out to the short call resident at 1600.
- Assist in coordinating rounds with the pediatric hospitalist teams.
- Provide education to patient families on rounds.
- Follow long term patients in the hospital with less active neurologic issues and discuss active issues with the Pediatric Neurology attending if they arise.
- Provide consultation for uncomplicated or patients on specific protocols (congenital cardiac defect patients).
- Attend didactic sessions, if interested.
- Assist with arranging outpatient follow up for current inpatients.
Latest revision: 5/22/2018, Adam Wallace