Inpatient - Based Rotations
Strong Memorial Hospital Inpatient Services:
Inpatient Neurology at Strong Memorial Hospital is divided into two main teams, General Neurology (Blue) and Stroke (Red), specializing in the clinical care of patients with a broad spectrum of neurological conditions. There is also a separate Epilepsy Service for patients requiring long-term EEG monitoring. The teams follow all patients admitted to the neurology inpatient services, and the census generally averages 10-15 for both Blue and Red, with several new admissions each day. Most Neurology patients reside on our Neurology inpatient unit, 5-1600, with incredibly dedicated, neuro trained nursing staff, techs, therapists, social workers and care coordinators.
Each team consists of a neurology PGY-2, a neuroscience APP (primarily on Red Team), a neurology, psychiatry or anesthesiology PGY-1, one or two 3rd year medical students and potentially a 4th year neurology sub-intern. There is a neurology PGY-4 (chief resident) who supervises each of the teams.
Residents on the Neurology inpatient services at Strong Memorial Hospital manage all aspects of patient care and perform all procedures under faculty supervision with progression of responsibility during the year. Neurology subspecialty consultation for inpatients with complex conditions is provided by fellows and attending neurologists, who collaborate with the primary teams to provide exceptional, comprehensive care to our most challenging patients.
Residents on the Neurology inpatient services typically have one evening float assigned per week, where they work with the Urgent Care/Evening float resident to cross-cover inpatients and see new consults until 8pm, when they sign out to the incoming night float resident.
Highland Hospital Consult Service:
Highland Hospital (HH) is a 261-bed community hospital owned by the University of Rochester. Our Department has a Neurology consultative service at Highland, which has a more community-based, “private practice” feel that is important for residents to experience during training. Adult Neurology PGY2 and Child Neurology PGY3 residents spend several weeks at Highland, joined by an in-house Neurology attending and 1-2 medical students. The average census is around 5-8, with several new consults called by primary inpatient teams and the emergency room daily. Consults are requested for conditions including seizures, encephalopathy, post-surgical and post-partum neurological complications, neurodegenerative disorders, and acute/subacute stroke. Neurology residents and attendings at Highland attend stroke codes from 8a-5p daily, assisted as needed by the Acute Stroke attending and fellow at SMH. The HH service provides time for teaching the residents and students, as well as many opportunities for observation of their clinical skills by faculty. After-hours and weekend consult coverage are provided by General Neurology and Stroke attendings at SMH and HH.
Strong Memorial Hospital Epilepsy Service:
The Strong Epilepsy Center (SEC) provides evaluation, management, and treatment of children and adults with epilepsy, with dedicated long-term EEG monitoring beds at both Strong and Golisano Children’s Hospital. PGY2 residents on the SEC service are responsible for the care of all Epilepsy service inpatients, supervised by Epilepsy attendings and fellows. The team assists with seizure semiology identification, medication initiation/adjustment and surgical planning, and consult with our group of specially trained neuropsychologists in cases where psychogenic nonepileptic events are suspected or captured.
Neuromedicine Intensive Care Unit:
PGY2 and PGY3 residents spend several weeks each year rotating through the Neuromedicine ICU at Strong Memorial Hospital, 8-1200. In the NMICU, residents work with neurointensivists, advanced practice providers, and highly skilled nursing and ancillary staff to provide primary intensive care to patients with severe conditions including acute respiratory failure, sepsis, status epilepticus, hemorrhagic stroke and subarachnoid hemorrhage, herniation syndromes, and cardiac arrest. Residents gain experience with ventilator management, invasive procedures, coordination of care with other subspecialty consulting teams, continuous EEG interpretation, and family counseling/goals of care discussions. The NMICU is a closed unit, and after-hours coverage is provided by faculty and APPs.
Urgent Care/Evening Float:
The PGY2 assigned to the Urgent Care/Evening Float rotation begins at noon and covers inpatient services for residents who have their regularly scheduled continuity clinic or in the case of illness/emergency. Beginning around 4:30pm, the evening float resident splits new consult coverage with the rotating day float resident until around 8pm when the night float resident arrives. The evening float assists nightfloat with urgent/active issues and new consults until around 10pm. On one afternoon per week, the urgent care/evening float resident performs outpatient lumbar punctures in our LP clinic, supervised by rotating volunteer faculty.
There are no 24-hour shifts for Neurology residents. Residents on night float work from 8pm to 8am the next morning, providing cross-coverage to patients admitted to the General Neurology and Stroke services and evaluating new consults called by other primary services and the emergency room. Patients seen overnight are staffed over the phone by chief residents and stroke fellows; general, stroke, and subspecialty attendings are also available at all times to discuss more complex or ill patients. Night float residents sign out any new patients to the appropriate services in the morning, and do not stay later to round. For their first night float rotation, PGY2 residents are paired with a PGY3 “buddy” to help them learn how to triage and quickly evaluate and staff patients.
Strong Memorial Hospital General Neurology Consult Service:
PGY3 residents consult on patients throughout Strong Memorial Hospital and Wilmot Cancer Center, seeing a wide range of acute and chronic neurological conditions. Residents from Internal Medicine and other programs frequently rotate on the Neurology consult service, and third year medical students are also assigned to this rotation for two weeks at a time. The consults are staffed by Neurology faculty, including neurohospitalists.
Strong Memorial Hospital Acute Stroke Service:
The Acute Stroke service provides consultations for both acute (i.e. “stroke alerts”) and subacute presentations of cerebrovascular disease in the emergency room and on inpatient services throughout the hospitals. Residents are actively involved with assessing patients’ NIH stroke scales, reviewing imaging, and weighing options for acute therapies such as IV thrombolysis and embolectomy. Consults are seen and staffed with Vascular Neurology faculty and fellows. Neurosurgery also responds to stroke alerts in the event that surgical management is warranted. The Acute Stroke Service is generally the busiest Neurology inpatient service.
Pediatric Neurology Inpatient Service at Golisano Children’s Hospital:
Under the supervision of Child Neurology faculty and fellows, Adult Neurology residents spend six weeks rotating on the Pediatric Neurology service at Golisano Children’s Hospital, which opened in 2015 and is physically connected to Strong Memorial Hospital. Residents on service provide primary neurological care to children of all ages with a variety of neurological disorders, and also provide consults to children admitted to the medical, surgical, and intensive care units at Golisano.
Resident spend another six weeks rotating through Child Neurology clinics at our satellite clinic at East River Road, only a five-minute drive from Strong Memorial Hospital. Here, they see a large number of children referred from our wide catchment area, working directly with Child Neurology faculty.
Acting Chief Resident Rotation:
All PGY4 residents function as chief residents, sharing clinical, administrative, and teaching responsibilities. One PGY4 is assigned to manage the General Neurology (Blue) inpatient service and a second is assigned to manage the Stroke (Red) inpatient service during the week. As acting chiefs, PGY4 residents supervise junior residents on the inpatient services, oversee handoffs during sign-out at shift changes, assist with running Morning Report and Neuroradiology conference, and teach medical students on service.
Psychiatry Consult Service:
PGY4 residents spend four weeks on the Psychiatry consult liaison service at Strong Memorial Hospital, working with Psychiatry faculty, residents, and APPs to assist in the evaluation and management of inpatient and ER patients with active and/or severe psychiatric conditions. During this rotation, residents learn the fundamentals of psychiatry most beneficial for board preparation and the independent practice of Neurology.