nocturnist job with tele neurology.

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bananas85

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There is a nocturnist job I am interested in. There is one big catch, they dont have neurology and instead have tele neurology. Given that it is one of the most common subspecialties consulted what questions do I ask?
Has anyone had experience with this and if so can you guide me. Should I stay away?

Strokes (tpa is managed by critical care since they are in ICU)
Status epilepticus or seizure I could see myself running into problems with...
Altered Mental Status. (CNS infection).

The critical decison whether to TPA or not to TPA..

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There is a nocturnist job I am interested in. There is one big catch, they dont have neurology and instead have tele neurology. Given that it is one of the most common subspecialties consulted what questions do I ask?
Has anyone had experience with this and if so can you guide me. Should I stay away?

Strokes (tpa is managed by critical care since they are in ICU)
Status epilepticus or seizure I could see myself running into problems with...
Altered Mental Status. (CNS infection).

The critical decison whether to TPA or not to TPA..

Wouldn't bother me. If someone comes in with concern for an acute stroke that should all be sorted out before you ever get involved. The fact that you don't have in-house neuro also makes me think you are not a stroke center, so even less likely for you to get involved.

I also would not say that neurology is one of the most commonly consulted services at all.

If you think someone already admitted is having an acute stroke, you activate whatever your acute stroke protocol is and transfer them to a stroke center.
 
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Wouldn't bother me. If someone comes in with concern for an acute stroke that should all be sorted out before you ever get involved. The fact that you don't have in-house neuro also makes me think you are not a stroke center, so even less likely for you to get involved.

I also would not say that neurology is one of the most commonly consulted services at all.

If you think someone already admitted is having an acute stroke, you activate whatever your acute stroke protocol is and transfer them to a stroke center.

Fun fact-you don't need a neurologist to be a stroke center.

To op-it is doable but very frustrating at times, especially with epilepsy admits or really dumb tia ruleouts. It can be a sign of desperation if they are trying to grab stroke money but can't afford a neurologist.
 
To op-it is doable but very frustrating at times, especially with epilepsy admits or really dumb tia ruleouts. It can be a sign of desperation if they are trying to grab stroke money but can't afford a neurologist.

Agreed. Personally I wouldn't do it unless the other aspects of the job are that much better. Then again I work in an area where every hospital has neurology so there are options and I can just work at the next closest hospital. Having said that, I don't think you should completely rule out working there. Ask current hospitalists during your interview how much it affects their workload.
 
I've worked at hospitals overnight with only tele neuro coverage. In my mind, it doesn't make the job a deal breaker. If I think someone is having a stroke, the nurse sets up the skype like machine and teleneuro is on the screen within minutes. they can access our charts, labs, and imaging in addition to place orders. They put in all the orders and its up to them to decide tpa or not. They also decide if the patient should be transfered to another hospital for higher level of care. If this is needed, I call the transfer center and initiate the transfer.

It is easier to respond to these compared to rapid responses. The teleneuro person does literally 98% of the work. The only thing they wont do is talk to a hospitalist at another hospital for a transfer. If they decide to give tpa, they put in transfer orders to ICU and all their BP protocols.

I personally wouldn't let it freak me out and wouldn't care if they had neuro in house or tele nuro overnight. During the day, thats a different story.
 
I've worked at hospitals overnight with only tele neuro coverage. In my mind, it doesn't make the job a deal breaker. If I think someone is having a stroke, the nurse sets up the skype like machine and teleneuro is on the screen within minutes. they can access our charts, labs, and imaging in addition to place orders. They put in all the orders and its up to them to decide tpa or not. They also decide if the patient should be transfered to another hospital for higher level of care. If this is needed, I call the transfer center and initiate the transfer.

It is easier to respond to these compared to rapid responses. The teleneuro person does literally 98% of the work. The only thing they wont do is talk to a hospitalist at another hospital for a transfer. If they decide to give tpa, they put in transfer orders to ICU and all their BP protocols.

I personally wouldn't let it freak me out and wouldn't care if they had neuro in house or tele nuro overnight. During the day, thats a different story.

Teleneurology at the one hospital I worked at that had it was very different than what you described. It did not involve skype or any video imaging capabilities. Instead, the nocturnist would call the number and first speak with a nurse and provide information such as pt name, mrn, room number, call back number. Then tele neurologist would call back in usually less than 10 min and just like a normal consult, you'd have to give the hpi and reason for consult. The tele neurologist had access to imaging and I believe labs but most times, I had to read off labs to them as I dont think they looked them over much. Being neurologists, they often would pull up head Ct or MRI on their own computer while on the phone and look at those images. They would give the nocturnists recommendations but would not order any labs or place any orders.

Very different involvement than described previously so clarifying what exactly happens with tele neurologist would be helpful.
 
Teleneurology at the one hospital I worked at that had it was very different than what you described. It did not involve skype or any video imaging capabilities. Instead, the nocturnist would call the number and first speak with a nurse and provide information such as pt name, mrn, room number, call back number. Then tele neurologist would call back in usually less than 10 min and just like a normal consult, you'd have to give the hpi and reason for consult. The tele neurologist had access to imaging and I believe labs but most times, I had to read off labs to them as I dont think they looked them over much. Being neurologists, they often would pull up head Ct or MRI on their own computer while on the phone and look at those images. They would give the nocturnists recommendations but would not order any labs or place any orders.

Very different involvement than described previously so clarifying what exactly happens with tele neurologist would be helpful.

This was exactly how it worked at mine. They didn't do orders for anything and definitely didn't handle icu management.
 
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