UNMC Rotations

General Neurology

The General Neurology service consists of an attending physician, a supervising resident (either a PGY-3 or PGY-4), a PGY-2 resident, and two to three PGY-1 level residents from either the neurology,  PM&R, internal medicine or psychiatry programs. Our nurse practitioner sees patients and coordinates discharge planning with the help of a floor case manager and social worker. Rotating medical students and/or observers complete the team.

The attending physician supervises the activity of the entire team and rounds with them daily. Rounds typically start around 0900 in the resident workroom. Then the senior resident on the service is responsible for overseeing and organizing the assignment of patients to the team.  Patients followed by PGY-1 level residents and other off-service rotators are also overseen by the senior neurology resident. The medical students and observers follow along with the neurology residents. Rounds take place daily seven days a week (including holidays), and potentially more than once a day in cases of emergency room or ICU consultations. The attendings also take time typically in the afternoon for resident education if time allows.

Stroke

The stroke team consists of a senior resident, an attending physician, a PGY-2 neurology resident, and a PGY-1 level resident from neurology, neurosurgery, internal medicine or PM&R programs. The nurse practitioner on the team follows patients and assists with coordinating discharge planning and assuring that stroke core measures are properly documented. Rounds typically take place at 0900 in either room 6819 in the Clarkson Tower or in the clerkship workroom.

Traditionally, the PGY-2 resident carries the stroke pager and responds to activations under the guidance of the supervising resident. Residents will be instructed to enter the Acute Stroke Protocol order set and accompany the patient to the CT scanner.  The stroke attending will also evaluate the patient and review imaging either via TeleStroke or at bedside, when available.  IV tPA will never be given until discussed and instructed to do so by the attending stroke neurologist. When indicated, CTA and CTP are obtained and if there is evidence of a large vessel occlusion, the neurology resident is then responsible for directly contacting the on-call neurosurgery attending for possible thrombectomy.

Night Float

Night coverage is provided for the general neurology, epilepsy monitoring unit and stroke neurology services by a designated night float resident. The night float resident arrives to take check-out from the day team at 5 p.m. and provides check-out to the day team at 7 a.m. from Sunday evening to Friday morning. Night coverage on Friday and Saturday night is provided a weekend night float resident from 5 p.m.-7 a.m. both nights. Night float is only provided by PGY-2 and above residents. There is an average of 4 weeks of night float per resident per year.

Epilepsy Monitoring Unit (EMU)

This eight-bed unit is located on the 6th floor of the Clarkson Tower. Patients are electively admitted on Mondays and are monitoring on video EEG throughout the week to either characterize spells or to localize known seizures. Intracranial monitoring, stereotactic EEG and epilepsy surgeries/procedures are also observed on this rotation. Residents review the long-term EEG data with the epilepsy attending and participate in rounds to assist in further clinical decision-making. This rotation is available both as a mandatory rotation and as an elective.

Weekends & Holidays

Just like during the week, the general and consult teams combine to form one team, while the stroke team round separately from them on Saturdays and Sundays. Four residents cover the weekend, including a PGY-2 resident, a PGY-3 resident, and either two PGY-1 residents from the inpatient services or a PGY-1 with an off-service PGY-4 resident. The PGY-3 resident rounds both days of the weekend and is expected to cross-cover for both inpatient services as needed in addition to giving checkout to the night float residents on Saturday and Sunday. PGY-1 residents round on both days and are able to depart after rounds at the discretion of the PGY-3 resident. They are expected to assist with new consults and admissions on both Saturday and Sunday.  PGY-4 residents are typically also on call at the VA Medical Center and may leave after rounds once their work is completed. They are not expected to see new consults and admissions at UNMC, though they can assist as needed.

Coverage does not change on holidays. Holidays that fall on weekdays operate just the same as any other weekday and the same is true for holidays that fall on weekends.

EMU patients are discharged either on Friday or earlier during the same week of their admission; and therefore, there are no weekend or holiday responsibilities for residents rotating in the EMU.