Inpatient Responsibilities and Procedures

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Neuro Y1 (PGY-3)

CN residents spend their first year in both Milstein Hospital and CHONY.  While on the Adult Neurology side (5 months), CN residents have an opportunity to learn basic skills in Neurology by rotating on the Ward, Stroke and NICU services as well as function as the Admitting Night Float resident.  During their Pediatric Neurology rotations carried out during the last quarter of their first year, CN residents experience a gradual immersion in CN while managing the CN Consult services (4 months) with ample attending oversight.

Neuro Y2 and Y3

The last 2 years of residency in Child Neurology mostly take place in the Children's Hospital of New York (CHONY). CHONY, formerly known as Babies Hospital, is 274 bed tertiary care center staffed by the Department of Pediatrics of CUMC. It includes all pediatric and surgical subspecialty areas with their respective fellowship programs, including critical care, neonatal medicine, genetics, endocrinology, cardiology, GI and all surgical subspecialties.  CN residents return to Adult Neurology rotations in more senior capacity while on the Adult Neurology Consult and Neuro-oncology services and have the option to pursue more electives such as Adult Neuro Outpatient, EEG etc.

The Child Neurology Consult Service:

Follows patients admitted in CHONY Tower, including PICU and NICU.  CN residents supervise 2nd, 3rd and 4th year Pediatric and Adult Neurology residents rotating on pediatric neurology. Call is taken from home and residents have remote access to laboratory results, neuroimaging and EEG studies. The pediatric neurology consult service is supervised by the CN attending on service.  The CN Consult service resident also staffs consults from the Newborn Nursery. The CN Consult resident also oversees all ER consults as well.

PEMU/Epilepsy Service:

As of 2018 July, the two services are now combined on the resident level, and are staffed by two Epilepsy attendings, one or two epilepsy fellows, one adult Neurology 2nd year resident, and NPs.

PEMU Service:

This service is staffed by an attending and a fellow as well as a NP and a rotating pgy2 Adult (or Child) Neurology Resident.  Patients are admitted ELECTIVELY to the PEMU service.

Each day the Epilepsy Fellow and PEMU attending will review all EEGs for patients on the PEMU service.

Monday-Friday NPs and the assigned resident will take hand off in the morning at 7:30am* and do all admissions and discharges.

Friday the same team will prep all admissions for weekend coverage.

On weekends and Holidays and overnight the on-call resident or overnight Hospitalist for the Child Neurology service will cover PEMU and epilepsy patients.

Signout will be done at each change of shift using IPASS system.

Pediatric Epilepsy Service:

Pediatric Epilepsy Service is as follows:

In general, an Attending and an Epilepsy Fellow staff this service which has two responsibilities:

  1. Read and report all non-scheduled inpatient video EEGs or inpatient routine EEGs i.e. Continuous EEGs in MS-CHONY
  2. Serve as primary attending for any unscheduled hospital admissions to non-ICU beds for any patients who are followed in the outpatient HP5 Epilepsy Practice or VC3 Thursday Epilepsy Fellows Clinic. This includes patients admitted to non-neurology services that require inpatient consultation as well as patients admitted for primary neurological reasons for which this attending would then be the Admitting attending.
  3. In the event that there is a concern that a patient may require closer staffing or have a non-epilepsy issue best staffed by the general neurology service a discussion between both the CN Consult attending and the Pediatric Epilepsy Attending will determine best placement for the patient.
  4. As of June 2017, patients still in the ER are staffed by the CN Consult attending until such time as they have a bed in the hospital.
  5. As of June 2017, all ICU patients are staffed by the CN Consult attending in collaboration with the Epilepsy attending reading CEEGs.

 The plan below details the responsibilities of each service as relates to inpatients on the Pediatric EMU service.  

Sign out: 

The NP or PEMU resident is responsible for signing out the PEMU service at the end of the day beginning at 4pm and for updating the Allscripts sign-out during the week using an IPASS format.  The PEMU admitting resident/NP and CN fellow will discuss the admitted patient with the EMU fellow on the day of admission.  The next weekday mornings, the child neurology resident will discuss overnight activities and daily plans for EMU patients with the EMU attending or fellow.  Direct resident to resident sign-out should be given at 7:30 am from the overnight in-house physician to the PEMU resident daily EXCEPT on Thursday mornings when the ward team will cover the patient until 9am when the PEMU NP arrives.

Monday through Friday

The PEMU staff is responsible for supervising all daily activities of these patients. This includes the daily exam, family discussion, notes and updating Allscripts sign-out lists using IPASS format.

Pediatric Epilepsy nurse practitioners will coordinate EMU beds and be responsible for all ancillary issues including coordinating SPECT, PET, MRI and ketogenic diet and arranging consultations on patients on their service.   CN staff will not coordinate any ancillary studies or consults on epilepsy patients.

The EMU service is responsible for all discharge notes which should be updated as of Friday and submitted by the discharging resident if this occurs over a weekend.

Weekends:

The EMU fellow/attending will see these patients and co-sign notes written by on-call residents.

ICU consults of epilepsy patient: 

The CN consult service will be the consulting physician for all ICU patients with seizures, including those on portable cEEG.  The CN and PE attending’s/fellows will discuss daily the results of ICU portable recordings and provide input as to management.  The PE attendings/fellows will sign out to each other these patients for after hours and weekend continuity of care.  

Child neurology consult resident manages all consults including emergency room, PICU, NICU and from pediatric floors.   All such consults should be evaluated by residents and seen by the child neurology service attending that day or the following morning based on clinical severity.

Resident Rotations

Child Neurology residents are assigned to the following rotations, for which detailed goals and objectives are provided above. These goals and objectives are outlined in the Child Neurology Resident Manual distributed to all residents at the beginning of their Child Neurology training each July. They will also be available on the departmental website. They are reviewed and updated annually.

The rotation schedule varies slightly each year based on total number of residents but meets the minimum criteria for eligibility to sit for the ABPN board exams, specifically:

  • 12 months of Child Neurology (4 months must be outpatient – 12 months is the minimum requirement)
  • 6 months of Adult Neurology total
  • 1 month Child Psychiatry
  • 2 months Basic Neuroscience (1 month of required neuropathology and 1 of EMG)
  • 3 months elective
  • 3 months of vacation

Year 1 (PGY-3)

  1. Adult Neurology Ward Service (6 weeks)
  2. Adult Neurology Stroke Service (4 weeks)
  3. Adult Neurological ICU (4 weeks)
  4. Adult Admitting Night Float (2 weeks)
  5. Adult EMU (4 weeks)
  6. Child Neurology PEMU Service (2-4 weeks)
  7. Child Neurology Consult Service (16 weeks)
  8. Vacation 1 month

Year 2 (PGY4)

  1. Pediatric neurology consult service (2 months)
  2. Pediatric neurology PEMU/Epilepsy service (3.5 months)
  3. Pediatric outpatient rotation (which includes attendance in the continuity clinic)*
  4. Pediatric neurology continuity clinic Tues afternoon weekly (alternating with MDA Clinic); Thursday afternoon (bimonthly)  
  5. Adult Neurology Consult (2 weeks)
  6. Adult Neurology Oncology (2 weeks)
  7. Required rotations (Neuroscience/neuropathology, Psychiatry)*
  8. Electives  
  9. Vacation 1 month

Year 3 (PGY5) 

  1. Pediatric neurology consult service (2 months)
  2. Pediatric neurology continuity clinic Tues afternoon weekly alternating with MDA clinic. Mon afternoon (bimonthly);
  3. Pediatric outpatient rotation (1 month), which includes attendance in the continuity clinic*
  4. Adult Neurology Outpatient Rotation (1 month)
  5. Required rotations (Neuropathology, Psychiatry)*
  6.  Electives (Adult and Pediatric)

* May be done in either second or final program year.