Download PMB/Child Neuro responsibilities

PMB/Child Neuro responsibilities
9/2013
Rounding/Communication:
 At 11:00 each day, the Child Neuro resident holding the pager and the PMB upper level
resident will coordinate communication of the plan for shared patients.
 For improved communication and education, interns and medical students are encouraged
to join the PMB Upper level resident in discussion of shared patients. This can be
coordinated within the primary team based on timing and availability.
 For any questions, always contact the Child Neuro Pager or the resident following the
child for clarification. The on-call resident is available 24 hours daily but is only in-house
from 8am-5pm.
Orders:
 Child Neuro will order any send-out labs, and EMGs.
All other orders will be written by the primary team (including medications, SPECT
scans, EEG, regular MRI/CT, and regular CSF studies)
 Order sets are available for PED EMU Admit, PED EMU Ketogenic Diet, and PED
Headache. Please use them for these patients.
 Send out labs are ordered REFERRAL LAB test. Type name directly into comments.
Neuro team will order majority of these tests.
 Both teams please be sure to clarify the need for contrast with MRI or CT and verify
before ordering
 For EEG order, write routine or video in the comments. The Peds Neuro resident must
call EEG techs to apply or d/c EEG leads.
Consults:
 Official consults will be requested only through the primary team.
o When primary team does not agree they must contact the Ped Neurology team.
 Discussion between consulting services often occurs and recommendations relayed,
however recommendations are carried out only by the primary team.
Direct admissions:
 Upper level should subscribe to the following group for information on direct admissions:
PEDS NEURO DIRECT
 The residents on pediatric neurology are responsible for all information of all direct
admits to be in this group. If there is information lacking, please call the Child
Neurologist on call
Follow-up appointment:
 Neurology residents will set up follow-up appointments. Appointments will be
communicated to Ward Team Coordinator [email protected]
LP’s:
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An upper level resident (either Pediatrics or Child neuro) must supervise any LP
Any LP including CSF neurotransmitters will be supervised by the Child Neurology
Resident
The primary team has first right of refusal on lumbar punctures but Child Neurology team
is available if necessary. When not medically emergent, LPs will be scheduled for
afternoons to avoid rounding responsibilities.
Primary team interns are encouraged to try LPs on child neurology patients. If pediatric
upper level is unavailable to supervise the procedure and Child Neurology team can be
available, neurology team may supervise.
Students on neuro clerkship are expected to attempt an LP and should have priority over
peds clerkship students.
Epilepsy Surgery Admissions:
 These patients often go back and forth between the floor and the PICU
 Dr. Elkay will share her cell phone number with nurses and residents taking care of ES
patients, so they can call her directly with any concerns. Emergent concerns after hours
should be routed directly to her.
 Every patient MUST have Brain Scan with SPECT ictal ordered at time of admission if
this is part of the patient’s plan. This may be ordered by the admitting (primary) team.
 Labs, meds, and consults will still go through the primary residents