Welcome to the Pediatric Neurology Clinic

• 3^rd Floor (VC-3), 
• Appointments: (212) 305-5187 Desk: (212) 305-9280

The Child Neurology Resident Continuity Clinic provides the child neurology residents an opportunity to become skilled in the care of children and adolescents with a variety of acute and chronic neurological disorders.  Beginning in 2012 this clinic experience was completely overhauled to more closely mimic the care provided in a private practice setting.  All child neurology residents as well as a small group of rotating residents from the adult neurology and general pediatric services are provided with a set schedule of patients. This schedule can be obtained the week before to give residents the opportunity to review their patients in advance of the visit.  Clinic begins promptly at 1pm following a weekly scheduled lecture on ambulatory child neurology topics or pediatric epilepsy and EEG review.  Under the direct supervision of the clinic director Dr. McBrian and the child neurology faculty who staff the clinic, child neurology residents become the primary neurology caregiver for their patients and follow up is scheduled with a single provider whenever possible to ensure continuity of care and improve resident education.  Child Neurology residents are responsible for following up laboratory and other testing results, visiting their patients when they are admitted to the hospital, and providing telephone patient support for urgent and non-urgent issues between visits. 

This aspect of the medical training program is of great importance because ambulatory care comprises the bulk of all child neurology practice.  Given its importance, all child neurology residents are required to attend weekly clinic session except while on vacation or when work hour rules require the resident’s absence (while on Night Float, etc.).  Should a clinic session need to be cancelled, it must be approved by the clinic director and the resident must arrange to have his or her patients rescheduled to their panel in a timely fashion.  Residents are scheduled between 6 and up to 8 patients per session with an anticipated show rate of 60%.  All PY-1 residents attend one general pediatric neurology clinic per week except during vacation or when on Night Float.  PY2 and PY3 residents also attend weekly clinic but are also occasionally assigned to the Pediatric MDA/Neuromuscular Clinic throughout the year.  A description of the Pediatric MDA/Neuromuscular Clinic is provided in the next section.

Please review these to familiarize yourself with the clinic operation and your responsibilities. The following points warrant emphasis:

1. Physician Responsibilities: Residents are expected to arrive at 1:00 p.m. immediately following the Tuesday noon didactic conference. If you know you will be late to clinic, please inform the attending.
2. Patient Scheduling: Every resident will be scheduled both new and follow up patients to see during a single clinic. Incoming PY-1 residents will see follow ups from an outgoing PY-3 resident who has graduated.
3. Patient Evaluations: Prior to calling a patient, residents are expected to briefly review the electronic medical record (Allscripts) but should spend no more than 5-10 minutes reviewing the record. It is preferable when possible to obtain your patient schedule in advance and review your patient panel 1-2 days prior to clinic. The resident then interviews and examines the patient, starts an electronic note, and formulates an initial differential diagnosis and plan. Every patient is then discussed with the pediatric neurology attending who sees the patient and agrees with or makes changes to the assessment and plan. Both the resident and the attending must complete the electronic note in Allscripts. The resident then completes prescriptions and orders for studies, and the administrative staff helps with scheduling studies and follow up appointments.
4. Patient Appointments: Child Neurology Clinic is an appointment only referral clinic. New patients should be referred by their primary care physician. New patients are scheduled to arrive at 12:30 p.m. for clinic intake. One hour, from 1:00 p.m. to 2:00 p.m. is allowed for evaluation of new patients. Patient who show up after 3:30pm may be rescheduled to permit appropriate time for evaluation and care.
   • Patients may also be given appointments at the time of hospital discharge from the inpatient child neurology or other hospital services or on discharge from the emergency room.  If a non-urgent follow up appointment is needed for a patient who is followed in the clinic the primary service may contact the ACN-Call center to schedule that appointment.  Should the patient be a New Referral or need more urgent follow up requiring double booking, the consulting child neurology resident is responsible for calling the 5-PERK line where the patient may be overbooked with the calling resident only.  Patients are not to be overbooked to other physician’s panel without their consent.  See # 12 below.
5. Follow-up: Each resident is responsible for follow-up care and procedures for his or her patients, including the follow up of ordered studies. Give your business card to your patients, and encourage them to show it to their primary MD.
   • Instruct your patients to call you in the clinic on your clinic afternoons for routine questions, and to call the clinic or page you through the hospital operator system for urgent issues. 
   • All patient communications should be documented in the electronic medical record at the time of the conversation to avoid confusion or medication errors.
   • We strongly encourage you to communicate with your patients’ other doctors directly, as you would in a private practice. The electronic medical record helps in communicating your plan to other CUMC physicians, however, sometimes it is necessary to call or page a patient’s PMD to help develop a plan of care together. If a patient’s primary doctor is not in the Columbia system and doesn’t have access to the electronic medical record, get your patient’s permission to fax your clinic notes and correspondence to their PMD. In addition, you may give your patient a physical copy of your clinic visit notes to bring with them to their next PMD appointment
6. Encounter Forms: Attached to each chart is an encounter form listing common diagnoses. Each physician must check the appropriate primary diagnosis and sign the encounter form. If a diagnosis is NOT represented, check "Other" and legibly print the diagnosis. The encounter form must additionally be signed by the attending.
7. Procedures: Rarely procedures are performed in the neurology clinic, including occipital nerve blocks, chemodenervation injections, skin biopsies, and lumbar punctures for older children who do not require sedation. These are scheduled by the physician with the Child Neurology Nurse. It is advisable to schedule procedures (especially lumbar punctures and skin biopsies, which take a longer amount of time) for a day other than the assigned clinic day. An attending must be present in clinic during the procedure. The resident and attending are responsible for obtaining informed consent for all procedures, and the clinic nurse will assist with time-out procedures. In general, most such procedures require sedation and must be scheduled through the OR scheduling desk.  Booking sheets are available in clinic and the service attending of the day serves as the attending supervising the procedure.
8. Admissions: On occasion, a patient will be admitted from clinic. This can be done two ways as either a direct admission for children who are clinically stable and do not require emergency intervention or by referring the patient to the pediatric emergency room.  To directly admit a patient to the child neurology service, CHONY admitting should be called and a booking sheet sent to the Admitting office if there are available beds on CHONY 6T. If there are no beds available or the patient has medical issues and needs to be evaluated in the Pediatric ER first, send the patient directly to the ER with the help of one of the clinic nurses. A note must be submitted in Eclypsis prior to transfer and the resident should call 305-6628 to alert the Pediatric ER staff of the patient and the plan.
9. Patient Counseling/Social Service Evaluation: There is a Child Neurology Nurse practitioner assigned to clinic (currently searching for replacement). The clinic NP can assist residents with complex cases that need counseling or assistance with medications, complex diagnostic evaluation, medical compliance or social needs. When this is needed, indicate it in your plan and verbally discuss it with the nursing and administrative staff.  There is no social worker specifically designated for neurology. If one is necessary the nurse can contact the social worker on call or referred to social work on the second floor.
10. Translation: Many of the patients in the clinic do not speak English as their first language, and all staff should use an interpreter if not fluent in the patient’s primary language (usually Spanish). Translation services are available at all times using the phone-translation services. Using the phone translator on speakerphone helps to simulate an in-person translator. In-person translators are also available during clinic hours, however, the phone translator services are often quicker and more accessible on short-notice.
11. Clinic Closing Time: The physicians should make every effort to complete all patient evaluations before 5:00 p.m. The clerical staff must complete their work by this time. Patient encounters completed after 5:00pm will be scheduled for studies and follow ups made by phone and mail the following day.
12. Urgent New Patient Referrals. The consult resident will be contacted and will determine whether a specific referral should be overbooked on Tues.  We have made two overbook slots for such eventualities.  Emergent referral should be referred to the ER.  All other referral should be faxed to the clinic on the referral sheet.