Stanford Neurohospitalist Program News
Lessons Learned from the Rapid Launch of Video Visits
Led by Clinical Assistant Professor Laurice Yang, MD, MHA, a team of Stanford neurologists and colleagues from the Evaluation Sciences Unit have described the experience of rapidly launching teleneurology in the midst of the COVID-19 pandemic.
Keeping Communication a Priority during the COVID-19 Pandemic
Hospital halls are usually bustling with patients’ friends and family, but are empty during visitor restrictions enacted to keep patients and healthcare workers safe. In a commentary for Neurology, neurohospitalist fellow Dr. Tarini Goyal explored how neurologists can still keep patients and family connected to the medical team.
Eponyms are here to stay
Calls to remove eponyms—diseases or tests named for individual physicians—from neurology have been made for decades. In a new study published in Neurology, Stanford medical student Jimmy Zheng and Carl Gold, MD, MS, Clinical Assistant Professor of Neurology found that the use of eponyms persists in the literature and among neurology trainees.
Alpha Omega Alpha Postgraduate Award
Dr. Tarini Goyal, Stanford's inaugural Neurohospitalist Fellow, has received the Alpha Omega Alpha Postgraduate Award for her work on developing a goals of care curriculum. Dr. Goyal is one of 10 recipients nationally and is the only neurologist to be recognized with this honor.
Neurohospitalist Team Celebrates Opening of Neurosciences Unit in the New Stanford Hospital
Our Neurohospitalist faculty team, together with our Neurology Department Chair, Frank Longo, MD, PhD, L5 Neurosciences Unit Nurse Manager, Victor Tamayo, RN, and senior resident, Hilary Wang, MD, MBA were excited to welcome our first neurology patient to our new, state-of-the-art L5 Neurosciences Unit on November 17th. A project 10 years in the making, the new space offers the latest in innovative technology, include a 10 bed epilepsy monitoring unit and advanced MRI imaging, as well as extensive gardens and plenty of quiet spaces for patients and families.
Stanford Inpatient Neurology Team tackles Patient Medication Education
A multidisciplinary team of neurologists, nurses, pharmacists, and case managers presented the findings of their project on improving patient understanding of the purposes of their medications at the Clinical Effectiveness Leadership Training course. The team, led by Dr. Brian Scott, MD piloted a program to identify and target patients in need of additional medication education, including both drug education as well as supervised practice with organizing medications, through a collaboration with pharmacy and occupational therapy. The project was so successful that they are now expanding the scope to include a “Medication Education Toolbox” available to patients and families through a web portal.
Checklist Improves ICU Transfers
A team of clinicians led by Neurocritical Care fellow, Nick Murray, MD has demonstrated that using a standardized checklist at the time of transfer from the ICU to the hospital wards is associated with reduced hospital length of stay for stroke patients. Now Online First in The Neurohospitalist, this study also found that the checklist was associated with improvements in residents' perceptions of patient safety.
Understanding Barriers to Effective Goals of Care Discussions
Neurohospitalist Fellow Dr. Tarini Goyal, colleagues in the Department of Surgery, and Clinical Assistant Professor Dr. Carl Gold have published an article in Neurology titled "Education Research: Understanding Barriers to Goals of Care Communication for Neurology Trainees." Now available online, the study describes the perspectives of Stanford Neurology residents regarding patient-level, resident-level, and systems-level barriers to effective goals of care discussions.
Variability in Prion Disease–Related Safety Policies
PGY4 Dr. Katherine Werbaneth, medical student Praveen Tummalapalli, and Clinical Assistant Professor Dr. Carl Gold have published an article in The Neurohospitalist titled "National Variability in Prion Disease-Related Safety Policies for Neurologic Procedures." Now OnlineFirst ahead of print, the study describes the lack of consistent safety protocols for neurosurgical procedures and lumbar punctures for patients with prion diseases at top hospitals in the United States.
Want to Become a Full-Time Neurohospitalist? Where the Training Opportunities Are Available
The Stanford Neurohospitalist Fellowship launches on July 1, 2019. Despite a major demand for neurohospitalists, this fellowship is one of only a handful in the country focused on training leaders in the field. An article in Neurology Today describes the growth of the neurohospitalist field and the current training opportunities.
Yield of Emergent CT in Patients With Epilepsy Presenting With a Seizure
Along with colleagues from UCSF, Clinical Assistant Professor Dr. Katie Kvam has published an article in The Neurohospitalist titled “Yield of Emergent CT in Patients with Epilepsy Presenting with a Seizure.” This study evaluates the diagnostic yield of CT in the emergency department and suggests strategies for avoiding unnecessary imaging.
Infected Implantable Pulse Generator
Neurology resident Dr. Shefali Dujari and Clinical Assistant Professor Dr. Carl Gold have published a brief report in The Neurohospitalist titled "Infected Implantable Pulse Generator." Now OnlineFirst ahead of publication, the article describes a novel diagnostic approach to identifying infected deep brain stimulator hardware.
Raising Awareness of Surfer's Myelopathy
Neurology resident, Dr. Eric Rider, and Clinical Assistant Professor Dr. Carl Gold have published an Image case in the September 2018 issue of Annals of Emergency Medicine. The article, titled "Young Man with Paraparesis," describes a patient who presented to the Stanford Emergency Department after his first beginner surfing lesson with leg weakness. He was rapidly diagnosed with a rare condition known as surfer's myelopathy and treatment was initiated, leading to significant recovery. The case was published to raise awareness of this condition for Emergency Medicine clinicians.
Expanding Access to Magnetic Resonance Imaging for Patients With Cardiac Rhythm Devices
Neurology Chief Resident Dr. Collin Culbertson and Clinical Assistant Professor Dr. Carl Gold have published a Viewpoint in JAMA Neurology released online first on July 2. The article describes recent studies demonstrating the safety of MRI in patients with "legacy" pacemakers and other cardiac rhythm devices. Drs. Culbertson and Gold call for collaboration among neurologists, radiologists, and cardiologists to develop processes to safely offer MRI to these patients. At Stanford, multidisciplinary improvement efforts have been underway for months. A safe, effective, patient-centered process for offering MRI to patients with legacy devices is expected to go-live in early 2019.
Stanford Resident/Fellow Quality Improvement & Patient Safety Symposium
Stanford Neurology residents and fellows presented a total of 20 posters at the 2018 Stanford Resident/Fellow Quality Improvement & Patient Safety Symposium, more than any other department. This accomplishment was recognized with the "Top Department Submission" award. Many of these projects focus on improving the experience of patients hospitalized with neurological conditions. Examples include optimizing the safety of feeding tube placement, identifying barriers to effective physician communication with patients facing serious illness, and expanding access to MRI for patients with pacemakers.
New Survey Reveals Gaps in Institutional Prion Safety Policy
In a survey study, PGY3 resident Dr. Katherine Werbaneth has found high variability in policies for prion disease precautions at top US neurology programs. The results were presented in a platform session at the AAN annual meeting on April 25. Dr. Werbaneth has worked on this project with Stanford medical student Praveen Tummalapalli, Chief Resident Lironn Kraler, and Clinical Assistant Professor Carl Gold. Their abstract was awarded an Abstract of Distinction, one of 24 such abstracts among more than 3000 submitted to the AAN annual meeting.
Team improves Neurology Clinic referral processing time
A team of neurology faculty, patient representatives, operations and performance improvement specialists recently completed a months’ long project to improve general neurology clinic referral processing time. Through a series of multidisciplinary focus groups involving RNs, MDs and new patient coordinators, process mapping and root cause analysis, they developed a new simplified pathway for triaging and processing referrals. The group’s efforts have already resulted in an average reduction of 2 days of referral processing time. The team was composed of Laurice Yang, MD, Katie Kvam, MD, Nicole Batino, operations specialist, Ting Pun, patient representative/advocate, and Hannah Wetmore, performance improvement.
The team hopes to continue these efforts into the next year with a plan to focus on streamlining the inpatient to outpatient referral and scheduling process as this is a critical gap for many patients and families.
Stanford medical student Harrison Hines and neurology residents Dr. Nick Murray and Dr. Sarah Ahmad have published a Video case report in Neurology titled “Paraneoplastic spinal myoclonus associated with Caspr2 antibodies.” The patient described in the report was seen by the Neurohospitalist consult service while hospitalized at Stanford. Clinical care and the manuscript were supervised by Professor Safwan Jaradeh and Clinical Assistant Professor Carl Gold.
PGY3 Neurology Resident Dr. Collin Culbertson has published a Teaching NeuroImage case report in the November 21 issue of Neurology, along with Neuropathology Fellow, Dr. Seth Lummus, and Clinical Assistant Professor, Dr. Carl Gold. Dr. Culbertson was a member of the clinical team that cared for a hospitalized patient who presented with left eye vision loss. After an extensive work-up, she was diagnosed with an uncommon inflammatory condition known as myeloperoxidase-anti-neutrophil cytoplasmic antibody-positive hypertrophic pachymeningitis.
Multidisciplinary team pilots checklists to promote high-value inpatient care
A multidisciplinary team from the Department of Neurology participated in Cohort 5 of the SHC Clinical Effectiveness and Leadership Training course (CELT). Pictured here with SHC leadership at the September 1 CELT graduation, the team included former residents and current fellows Tresa McGranahan and Rebecca Miller-Kuhlmann, H1-G1 patient care manager Elisa Nguyen, clinical nurse Karlene Mills, and case manager Judy Pettibone. Clinical Assistant Professor Carl Gold served as the team leader. The team's CELT project, "Delivering High-Value Care on Inpatient Neurology: A Multidisciplinary Initiative," focused on developing and piloting checklist tools to promote high-value practices on the neurohospitalist service.