NVST/NVL1 workflow updates:

• -weekends: NVL1 staff helps and rounds on NVL1 list; at approximately Noon/1pm, ->TOA (transfer of accountability, handover) to NVST on-call staff and resident - running of the list; then 1 (i.e. ONE) stroke staff, the NVST staff, remains on-call with the trainees (resident+fellow, as applicable) for all patient care issues. The NVST staff is the primary point of contact after TOA. NVL1 schedule continues to be made Monday-to-Sunday, and NVL1 staff who has departed, will be available to the NVST staff for questions and support PRN.

• -Sr resident (or Sr designate) divides the list DAILY, assigns trainees and fellows to patients on a daily basis; respecting the fellow role (who should know all the patients on list), and this list assignment will allow residents/Srs to be part of the NVL1 team on certain days; as possible within constraints of team size. Naturally, in those instances, fellow can then focus on ward (this facilitates the fellow on-service know the whole list even more);  on days/weeks were there is significant understaffing/lack of residents (e.g. no on-service residents, or low number of residents 1-2 residents on service), the current state stands, fellow helps with NVL1, then transitions to ward after around 10:30AM to join NVST team; Both staff help trainee teams at all times and remain available to them.

  • Fridays we have 2 fellows -> current state stands for fellow assignment, one fellow to each team

  • 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 as applicable

• -Transfer of level 1 patients to NVST:

  • NVL1 team remains MRP that day, as patient transitions to the ward; includes the discharge of patient if bed becomes available same day. On day of transition - NVL1 note is written as a transfer note - so the NVST team has a better written handover than a usual progress note. Usual handover protocol in current state continues.

• -fellows engage in Jr attending role, reviewing consults, off-hours, on days they have a proper post-call day; Friday, Saturday; giving fellows the requested JA experience; see email about fellows sent previously for their R/R

• -Gen Neuro staff will be asked to be flexible in review time on weekends; given the MRP stroke neurology inpatient demands. Plan is to provide an update on this at future Division staff meetings + explain rationale