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Bronx VA

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Bronx VA

The Neurology Service at the Bronx VA Hospital is a consultation-only service. Two residents (generally a PGY-3 and PGY-2) share equal patient care responsibility. The team often includes a medicine PGY1 rotator and a medical student. The residents field all consults called in to the neurology service, and make some initial diagnostic and therapeutic decisions before presenting the case to the consult attending. The residents are then responsible for following up on the consult patients daily. There is a weekly clinic on Thursdays at the VA precepted by Dr. Elder.

In addition to patient care responsibilities, the PGY-3 resident assists with the educating the team in both medical knowledge, as well as systems-based practice education pertaining to learning to work in the VA hospital system.

Bronx VA Resident Orientation (Compliments of Dr. Wiener)

Getting to the VA

  • The VA bus is a regular-sized white charter bus that pulls up in front of the Icahn building on Madison (at 98th St). The bus leaves at 8:15 am. However, shuttle schedule may change so please check prior to each rotation.

  • If you miss the bus, you can take the 6 train to 125th street then transfer to the 4, and take it to Kingsbridge Rd. Walk away from the giant overpass on E Kingsbridge Rd, you'll hit the VA in 5 blocks (but it's a long 5 blocks).

  • Cab rides cost ~$20 at night without traffic, more during the day. Off-hours travel if you come in at night can be reimbursed by the department.

  • The resident's room is on 3E, across from the neurology clinic. The clerks have 2 keys to the clinic that they give to the residents at the start of each rotation. Please keep track of your key and return at the end of the rotation.

Credentialing and Computer Access at the VA

AT LEAST ONE MONTH BEFORE your first day, to get your ID and computer access, go to 7A-11 at little after 8AM. Ask for Indra Naipal x6757. You need 2 forms of ID (drivers license + another ID e.g. passport, social security card, etc) and names must match exactly.

If you feel would like to obtaining home CPRS Access, follow the below instructions: Note: prior residents have had logistical issues and been unable to view radiology even after access was obtained.

  • visit VA portal while at the VA to request home access
  • Dr. Elder will receive an email, but you can also alert him about your request. He will approve it.
  • You will receive an email directing you to a website where you can view instructions to use CAG home access.
  • You will need to call IT to obtain an exemption to use your username rather than VIP (unless you have a home VIP card reader)
  • Domain\Username: VHA03\VHABRXusername (no number)

VA Schedule

  • Typically 9am-5pm (On-site shift begins when 8:15 shuttle arrives)

  • Rounds typically occur at 10 am in the resident room

  • VA clinic is on Thursday afternoons precepted by Dr. Elder.

  • On Fridays, Dr. Elder will telecast the Grand Rounds in the resident room.

Consults

  • Location for inpatients should be Brx neuro bedside visits. Every note written on the patient that day should be linked to the same neurology bedside visit. Consults in the ER are linked to Brx Neurology Consult location.

Resident clinic

  • Thursday afternoon supervised by Dr Elder. Notes should be linked to Brx Neurology Consult visit location not Brx Neurology Bedside visits. This should happen automatically when the clerk checks in the patient.

Radiology Rounds and Grand Rounds

  • Radiology Rounds - Tuesdays 11:30am - 12:30pm. Please email a list of patient name, last 4, and images to be reviewed to Dr. Park before departing on Monday.

Stroke Codes

  • Stroke code protocol (on VA Intranet under clinical section)

    • Must respond within 15 minutes of page
    • Residents to keep a list on wall in room of all stroke patients seen
    • Dysphagia screen must be performed and documented on all stroke patients before any oral intake.
    • NIHSS must be done on all stroke patients: Within 45 minutes of triage if in tPA window OR Within 24 hours if outside of window

  • If pt receives TNK the resident must come to the hospital to see the patient if they were not there at the time of treatment.

  • Even if stroke was several days before presentation or diagnosed incidentally on MRI - NIHSS and dysphagia screen must be documented in the chart.

  • Educational materials (Beatle Baily brochure which is in resident’s room and in our clinic area) must be given to all stroke patients before d/c or before signing off case and documented in the chart.

  • All documentation of NIHSS and dysphagia screen must be made with time of initiation. This documentation should be made in stroke assessment note title.

  • This note title includes: NIHSS, Dysphagia screen, Physician acute rapid stroke assessment (inclusion and exclusion criteria for tPA protocol), and stroke education

LVO strokes

  • Call Montefiore Call Center (718-920-2800) for an ambulance and to speak with Stroke Fellow as per Dr. Daniel Labovitz the Stroke Center Director.  

On call at the VA

  • Bring your personal pager with you at all times, i.e. when commuting.

  • When you're on call, you carry pager 7839 around the hospital during the day. As of 2020, we now have a Vocera as well, which you should wear. The front desk staff can train you on using vocera, and stroke codes should be announced through this device as the pager does not always alert you that the page is a stroke code. These devices should stay at the VA in a safe place and not travel home with you at night. In hospital call is generally from 9am - 5pm (so you can take the 5:30pm shuttle home) after which pages will be forwarded to your personal pager.

  • Consulting teams are supposed to page you for every new consult, but sometimes consults are ordered in the system and just print out to the computer in the resident's room.

  • Nights or Weekends: if you get called in for a stroke or urgent case, you may use Uber/Lyft for transport. Use the Uber ISMMS business account if possible or else save your emailed receipt and provide a copy of your credit card statement with the ride on it to the Department coordinator to arrange reimbursement. Please use Pool or ride-share services when returning from the VA or for non-urgent rides.