Description:
At Mount Sinai (Site 1), nights (8pm to 8am) are covered by a PGY-2 nightfloat resident six days a week and a PGY-2 resident on 24-hour call one day a week. Each PGY-2 does two to three 2-week blocks of nightfloat. PGY-2 residents on the Stroke or Floor Service have one or two overnight calls per month. Work-hour regulations are strictly observed. The responsibilities while on night call at Mount Sinai include covering both the Floor and Stroke inpatient services and seeing consultations in the Emergency Department and throughout the hospital. An on-call PGY-4 is available by phone, and an on-call Attending is available to discuss all Emergency Department admissions and discharges
The covering neurology resident must see all patient consultations called by the Emergency Department or elsewhere in the hospital, generate the initial differential diagnosis and treatment plan, discuss the case and plan with the covering neurology attending, communicate with the ED team to ensure that Neurology's recommendations are understood and followed, and make disposition decisions. All residents are supervised by an attending, either the Consult Attending during the day or the On-Call Attending on evenings and weekends. The Emergency Department at Mount Sinai Medical Center (Site 1) is covered by the PGY-4 Neurology Consult resident during the day and by the PGY-2 short-call and nightfloat residents in the evenings. PGY-2 residents discuss cases by phone with the on-call PGY-4 resident. All patients discharged home from the Emergency Department must be discussed with the neurology attending on call.
Goals
To teach residents to provide comprehensive and effective patient care overnight, both to inpatients on the neurology service and to patients seen in consultation in the Emergency Department and on other inpatient services
To provide close supervision and meaningful guidance and instruction by both the PGY-4 resident and attending on call to foster increased clinical independence and graduated responsibility.
Objectives
The resident will:
Accurately and efficiently gather information about patients seen in consultation in order to develop and carry out a diagnostic and therapeutic plan, to be overseen by the senior neurology resident and attending on call (Patient Care)
Work with consulting teams such as the Emergency Department and the Medical Service to provide the best patient care possible (Patient Care)
Increase their clinical knowledge and judgment by accurately and succinctly presenting the cases seen by them overnight in consultation to an overnight on-call attending and a senior neurologist the next morning during Morning Report (Medical Knowledge)
Be able to locate and assimilate scientific evidence quickly in order to apply it to their patients in real-time (Practice-Based Learning and Improvement)
Write comprehensive, clear and effective consultation and admission notes to be used by the day teams taking over care of the patients from the nightfloat resident (Interpersonal and Communication Skills)
Obtain and provide adequate sign-out to the call and day teams, recognizing the nightfloat resident's role as an extension of the healthcare team (Interpersonal and Communication Skills)
Develop the time-management skills necessary to triage consultation requests and floor work responsibly (Professionalism)
Learn to effectively coordinate patient care in the Emergency Department (Systems-Based Practice)