Weekdays:

• NVST → up to 13 ward beds + codes + outside calls + non-ICU consults

• NVL1 → up to 8 NVL1 beds + ICU follow-ups/consults

• Fellow rounds with NVL1 early AM, joins NVST by ~10:30–11am; maintains situational awareness on all patients

Weekends:

• NVST takes all consults (including ICU)

• NVL1 rounds their list, then hands over (TOA) to NVST by ~12–2pm → NVST becomes single point of contact for everything

• NVL1 staff stays available staff-to-staff after TOA

• Some weekends: one stroke staff covers both roles

Key Changes (July 2025):

1. Weekend simplification — trainees deal with fewer on-call staff (stroke + GenNeuro only after TOA)

2. Trainee exposure to NVL1 — Sr resident assigns trainees across both lists daily when staffing allows

3. Transfer day (NVL1→Ward) — NVL1 staff stays MRP on transfer day; their progress note = transfer note; NVST assumes care next day. No duplicate notes.

Fellow bottom line: Know every patient on both lists. Can take a Jr attending role (reviewing consults) when staffing permits.

NVU Stroke Staff Roles - NVST and NVL1 - overarching principles

WEEKDAY NVST and NVL1 Staff Roles:

• • NVST (i.e. Ward Staff) - is MRP for up to 13 physical stroke ward beds, on the NVU + codes + outside calls + all Non-ICU consults (wards, ED)

  • NVL1 staff - is MRP for up to 8 physical beds on NVL1 + follow-ups on ICU patients and new ICU consults

WEEKEND NVST and NVL1 Staff Roles:

• • NVST (i.e. Ward Staff) - is MRP for up to 13 physical stroke ward beds, on the NVU + codes + outside calls + ALL consults (ICUs, wards, ED)

  • NVL1 staff - is MRP for up to 8 physical beds on NVL1 + follow-ups on ICU patients

  • In the afternoon on weekends, when there are TWO stroke staff - handover occurs between the NVL1 team ->NVST team, and then the NVST staff (who is on-call) remains the first point-of-contact for all stroke patients (NVST+NVL1). NVL1 staff remains available to the NVST (on-call) staff for any issues, staff-to-staff

  • Some weekends - ONE stroke staff - is covering NVST + NVL1 roles

Fellows:

• • Fellows are Expected to know (i.e. have situational awareness) on all the patients on the list = meaning NVST and NVL1 services when on service and/or on-call

Modifications to NVST/NVL1 workflow updates - July 2025 onwards

Weekend Operation modification, response to trainee feedback/request to have to review with 2 on-call staff (NVST/Stroke and GenNeuro) - rather than 3 staff on-call (NVST/Stroke, NVL1, and GenNeuro)

• • Please note: There are weekends when ONE Stroke staff covers both NVST and NVL1 - thus, there are 2 Division of Neurology Staff on-call - ONE Stroke Staff [covering both NVST (i.e. ward), NVL1)] and ONE GenNeuro Staff

  • On weekends when THREE staff on-call for the Division of Neurology  (NVST/Code Stroke Staff, NVL1 Staff, and GenNeuro Staff):

    • NVL1 staff (the second stroke staff) helps and rounds on NVL1 list; and by approximately 12-2pm they provide ->TOA (transfer of accountability + handover) to NVST on-call team. At this point, ONE stroke staff remains on call for NVST/Codes/NVL1/ALL consults and is the single-point of contact for the Trainees (resident(s)/fellow) on-call.

      • Before TOA, NVL1 staff is primary for NVL1 issues

      • The NVST staff is the primary point of contact after TOA for New issues (including inpatient code stroke on NVL1 patients as part of on-call duties).

      • NVL1 staff who has departed after TOA, will be available to the NVST staff for questions and support as needed (staff-to-staff communication)

  • Gen Neuro staff will be asked to be flexible in review time on weekends; given the MRP stroke neurology inpatient demands.

Weekday/Daily Operation on NVL1, response to trainee feedback, to have exposure to NVL1 patients

• • Normally NVL1 is rounded on by the NVL1 staff + stroke fellow, and then the stroke fellow joins the Stroke Team to help with inpatients + codes by approxmately 10:30am-11am.

  • When the stroke team is sufficiently staffed with a resident/trainee team complement - the Sr resident (or Sr designate) divides the list DAILY, assigns trainees and fellows to patients (across NVST and NVL1) on a daily basis; respecting the fellow role (who should know all the patients on list)

    • This facilitates Neurology residents, Off-service residents interested to be part of the NVL1 team on certain days (staffing allowing).

      • this allows the fellow to focus even more on the NVST/ward patients.

        • on days the fellow focuses on the ward, the fellow remains looped on NVL1 plan (e.g., attends NVL1 huddle/receives brief run-through) to maintain whole-list situational awareness.

  • On days when there is under-staffing - lack of trainees (e.g. no on-service residents, or low number of residents 1-2 residents on NVST service), the current state stands:

    • NVST staff helps round on ward + codes/consults as per role

    • NVL1 staff + fellow round on NVL1 early AM - then by 10:30am-11:00AM, the fellow transitions to help NVST/ward team round

    • Both staff help trainee teams at all times and remain available to them

  • Please note: Fridays we have 2 Stroke fellows on -> current state stands for fellow assignment, one fellow to each team

Care and Transfer of NVL1 patients to Ward, response to trainee feedback to not duplicate efforts (notes, review, discharge summary)

• • NVL1 staff remains MRP on day of transfer from NVL1 to NVST (ward)

    • On transfer day, the NVL1 daily progress note serves as the transfer note (additional details added as clinically warranted)

    • NVST Staff and fellow responsible next day to update their team when assuming care of the transferred patient as per standard operation - this includes bullet rounds discussion of all patients.

      • NVL1 staff handover to NVST staff directly or via the whole-team communcation system and/or on bullet rounds next day

  • NVST patients that deteriorate, can be transferred to NVL1, with staff-to-staff TOA, NVL1 team then assumes care

  • Please note - on transfer day NVL1->NVST - sometimes the PAA (i.e. ward clerk) changes the MRP name to the NVST staff (instead of keeping it under the NVL1 staff), this can be corrected by calling front-desk PAA or using the MRP tool on the EMR.

    • MRP should become the NVST staff following day of transfer.

Fellow Role

• fellows may engage in Jr attending role, reviewing consults, on days with sufficient staffing in discussion between fellow and stroke staff

• fellows review consults, on-call, with trainees when on-call