OVERVIEW
Neurology residents provide weekend coverage for the following services at UMMC
CNS
Consult
Stroke
Resident coverage will largely be provided by on-service neurology and psychiatry residents. There will also be some coverage provided by off-service residents. Weekends will alternate on an A/B schedule.
In addition to the above residents, weekends will also have a weekend consult call resident that will see consults and respond to BAT calls during the morning so that the CNS, Consult, and Stroke teams will be able to round with fewer interruptions.
Refer to the page on Weekend Call for additional information on the weekend consult call resident and weekend call in general.
ATTENDING COVERAGE
Three attendings for each service (CNS, Consult, Stroke) will be present in-house on both Saturday and Sunday mornings for rounds. These attendings will generally be the same attendings that picked up service on Friday
Attendings are on service for one week blocks and switch every Friday
After sign-out and night float presentations, all 3 services are expected to round independently.
Attending on-call coverage is variable based on weekend day and time (daytime vs nighttime). Please check EZCall for attending call schedules.
WEEKENd ROUNDING ROLES: LOGISTICS, TIPS, AND EXPECTATIONS
The weekend brings challenges of fewer personnel in-house and coverage of unfamiliar patients. While the call schedule is designed to mitigate these challenges as much as possible, they are sometimes unavoidable. Some weekend services will operate very similarly to a weekday (Weekend A stroke and Weekend B CNS). Other weekend services will operate differently.
GENERAL EXPECTATIONS AND SUGGESTIONS FOR ALL RESIDENTS
If covering a new service (e.g. covering CNS while on Consult rotation), residents must obtain sign-out from the service resident
Pre-writing notes the day before can be very helpful
The plan can be drafted based on expected treatment course from sign-out
The HPI and exam must be filled only after seeing patient
Reach out to your attending the day before to coordinate when you will round
Keep your co-residents working the weekend in the loop regarding high service burdens to allow for flexibility in resident assignments and coverage (see below)
DOUBLE RESIDENT SERVICES (WEEKEND A STROKE & WEEKEND B CNS)
These services will operate very similarly to the weekday service.
Two residents that have been on the service are assigned to weekend coverage.
The attending they work with will also be the same they worked with on Friday.
Patient assignments should be discussed between the two residents on the Friday before the weekend.
Newly admitted patients should be subsequently divided between the two residents.
SOLO PGY4 SERVICES (WEEKEND A CNS & WEEKEND B STROKE)
The solo resident will round on all patients with the attending. This should be tenable most weekends as the average census on either CNS or Stroke hovers around 10 patients. It is understood that at times the census can be much larger. The following modifications to pre-rounding and rounding can be used to mitigate the work burden on these services.
Bedside Pre-Rounding is not necessary except for unstable or acute patients - Residents on solo services are not expected to see patients before rounds unless there is an acute clinical concern. Pre-rounding can otherwise be done strictly via chart review
Discovery rounding and note writing during rounds is permissible - Residents on solo weekend services are allowed to “discovery round,” meaning that they are permitted to first look into chart data during table rounds with the attending (similar to ICU style rounding). Residents are also permitted to write parts of their notes while they are table rounding with the attending as treatment plans are formulated.
PGY-2 COVERAGE OF CONSULTS
This can feel very atypical for PGY-2 residents as they generally do not lead rounds during the weekdays
As always, sign-out is paramount to success. In particular, sign-out for this service should answer the following questions:
Which patients should we do a follow-up visit with the attending? What is the reason for this follow-up?
What test results should we follow-up on over the weekend with the attending? What recommendation should we make to the primary team based on this result?
In the morning before rounds, the following must be established
Which patients are new consults that need to be staffed with the attending?
Which patients are old consults that require follow-up with the attending?
Where are these patients located?
In what order should we see these patients?
If you have questions about any of the above, please consult with the PGY4 resident on weekend coverage (either CNS or stroke PGY4) before starting rounds so that you can be prepared to lead rounds with your attending
Unless there is an acute clinical concern, you are not expected to see patients at bedside before rounds with the attending.
FLEXIBILITY DURING HIGH BURDEN CENSUSES
There will inevitably be times during the year when services will have very high census burdens and others will have lower burdens. Residents covering the weekend are encouraged to communicate and coordinate potential deviations from the set assignments to help one another. If deviations from the above assignments are made, you must adhere to the following guidelines.
Psych rotator must know assigned patients on the Friday before their weekend call - Sometimes Stroke and CNS services can be imbalanced. If either service is light, the psych rotator can temporarily float to the other service. In general, we will try to keep the psych rotator on their assigned service as it provides them with better continuity and education.
Example: It is a “Weekend A” schedule and by Friday at 5pm the stroke service has 6 patients while the CNS service has 14. A collaborative decision is made on Friday between the residents to have the stroke PGY1 psych intern work on the CNS service instead of the typically assigned stroke service.
Rounding is expected to occur simultaneously starting around 8am for all services - If a resident on a lighter service splits their assignments between two services, they should not delay rounding with their standard assigned service.
Example: It is a “Weekend A” schedule. The off-service PGY2 covering consults only has 2 consults and 1 follow-up to staff with the consult attending. They agree to help the PGY4 solo covering CNS service, but will still round on time with their consult attending. When consult rounds ends early, they will assist with PGY4 covering CNS while also completing their work for the consult patients.
Long Call and Weekend Consult Call
See also: weekend workflow
Two residents are on-call during the weekend
Long Call Resident: Inpatient service from 7 AM to 12 PM and then On-call from 12 PM to 8:30 PM
Weekend Consult Call Resident: On call for new consults that come in 7 AM to 12 PM. From 12PM to 3PM, they will do one-third of new consults that are called.
Pager Coverage: The Weekend Consult Call Resident is responsible for forwarding the VA and General Consult pagers to their own pager at 7:00 AM. The Stroke and General inpatient (CNS) teams will handle cross-cover for their patients until they sign out (after 12). The Long Call resident will take over the pagers at 12:00 PM promptly and forward all service team pagers to the stroke pager.
The role of the weekend consult call resident is to prevent disruption of rounds by new consults during these weekend work days when there is reduced staffing and to assist the Long Call resident early on during call.
The Weekend Consult Call Resident does not participate in rounding.
The Weekend Consult Call Resident will write the daily progress notes on any EMU patients.
The Weekend Consult Call Resident is responsible for all consults called in before 12:00 PM. However, once the service work is completed, all weekend residents should divide the consults called in for maximal efficiency (e.g. If the service is not too busy and rounds end at 10:30 and the weekend consult resident still has multiple consults to see that were called in that morning, the inpatient team residents should begin to see some of those consults). No residents should sign out and leave for the day until all morning consults have been or are being seen.
If there are consults remaining to be seen at noon, they should be dispersed among all in house team members before anyone goes home for the day. The goal should be for all the non-call team members to leave at approximately the same time. As a last resort, a maximum of 1 can be passed onto the short call resident.
If there are any questions regarding division of labor, the PGY4 resident on for the weekend will be the final decision maker.
Last Updated: September 2023