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, 2 PGY-2 neurology residents, 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 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 Tele Stroke 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, stroke neurology, neurocritical care consults, and epilepsy monitoring unit services by a designated night float resident. Night float resident is also expected to see new consultations from the ER and other inpatient services. 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, starting in the second half of PGY-2. There is an average of 4 weeks of night float per resident per year. 

Neurocritical Care Consult Service 

UNMC is home to a robust, multidisciplinary neurocritical care unit, staffed by neurocritical care-board certified physicians, who are almost entirely neurologists. With this staffing available, the department has begun to offer neurocritical care consultation services to ICU-level patients in the hospital, which are separate from the pre-existing general neurology and stroke neurology inpatient team services. There are two mandatory neurocritical care rotations in the residency curriculum, in addition to an elective neurocritical care consult service rotation. This service is covered at night by the night resident (or swing shift resident as necessary for workload distribution) and is staffed by a dedicated neurocritical care faculty member in their off weeks from attending on the neurosciences ICU. On weekends, the neurocritical care consult service is covered by the stroke senior on the inpatient stroke service. 

Swing Shift 

Swing shift coverage is designed in response to resident feedback and involves a designated resident assisting the day teams and night float from 3 p.m. to 11 p.m. from Monday through Friday. The resident takes every other consult from inpatient general neurology starting at 3 p.m. and from inpatient stroke neurology starting at 4 p.m., and alternates consultations/stroke activations and/or assists with other floor coverage issues with the night float resident until 10 p.m. Swing shift also serves as backup for the night float resident, with work hours modified pending continuity clinic scheduling.  

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

At least four residents cover the weekend general neurology and stroke inpatient services, which always include a senior neurology resident on each team, with a second junior neurology resident and/or off-service resident. The senior resident on each team 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. Junior residents round on both days and are able to depart after rounds at the discretion of the senior resident. They are expected to assist with new consults and admissions on both Saturday and Sunday.   

Holidays that fall on weekdays are staffed similarly to weekend days, pending service volumes. 

EMU patients are usually discharged either on Friday or earlier during the same week of their admission. Those that do not get discharged on Friday or earlier in the week, are seen by the attending epileptologist on weekends - so there are no weekend or holiday responsibilities for residents rotating in the EMU.