View source for Harbor: ED to UCC

== ED to UCC ==
* Goal:  Get patients age 18+ to the most appropriate level of care to facilitate expedient care and increase ED capacity for critical and undifferentiated patients given the beds lost to boarding.

===Direct from Triage===
* Revised 11-12-2025
* Quick Reg at Router – chief complaint and triage priority (most likely “routine”)
* Patients to “Waiting for Triage” section of the AWR
* RN Triage & Physician/APP MSE exam and documentation completed, and patient felt to be appropriate for UCC, defined as any '''ESI 4/5 who does not have an emergency medical condition''' (health issue that requires immediate medical attention to avoid severe harm, permanent disability, or death) '''and is stable to be discharged without additional stabilizing treatment prior to being seen at the UCC within the next 24 hours'''
* Provider checks '''banner bar for “DHS/DHS Eligible” or Empaneled DHS Provider'''
** If patient is not appropriate for UCC or is not “DHS/DHS Eligible”, proceed with usual process (place all relevant orders, proceed to ED registration, tasking, FastTrack)
* If the patient is appropriate AND eligible:
** If pain medication is needed
*** Triage physician/APP orders necessary pain medication (no other orders)
**** No need to order the “OK for UCC” event in Orchid
*** Triage nurse administers the medication and documents in Orchid
*** Triage Nurse calls UCC x64110 (alt: x64111/64115/641118) to notify UCC RN of 
**** Patient Name
**** MRN
**** DOB
**** Medication name and time given
**** Time pain reassessment due
*** Triage physician/APP orders “Discharge Patient” in Orchid
*** Triage nurse hands patient map to UCC and notes at the top date and if pain medications were given
*** Triage nurse instructs patient to go to front desk of UCC (RED LINE) to “complete their check-in process” (do not say for registration as this often has financial connotations)
**** If the patient does not know how to get to UCC, arrange for escort from ED
***** Volunteer at the Router
***** USA x66973
***** RME Charge RN x66950 for a Nursing Assistant
***** HMA x66968/9
**** Do NOT remove wrist band (helps facilitate more rapid registration at UCC)
**** Triage Nurse removes patient from the Tracking board (“Depart to Other Area of Facility”)
**** Patient is re-registered at UCC (new FIN) and appointment made
*** '''UCC PAC will call RME Charge RN x66950 when all appointments are full''' (24-hour rolling opening of appointments);  at this time, all patients will be seen in the ED.

===2nd Chance===
* Revised 1/21/2026
* If the '''banner bar does NOT say DHS/DHS Eligible''', and they are an ESI 4/5 patient that the triage provider feels is appropriate for UCC, right click the “Events” column, click “OK for UCC”, then click “OK” which will place the icon on the board.  When the '''ED PAC team sees this icon in an ESI 4/5 patient, they will offer the patient an appointment at the UCC noting the estimated 6-hour ED wait'''.
** If the patient is not eligible for UCC or declines an appt at UCC, registration will change the icon and the patient will then need to be seen on FastTrack. 
** If an appointment is made, the '''PAC team member will hand the appointment slip to the RME flow nurse (or RME charge as backup)''' and place the patient in the green chairs (in case they need pain reassessment post medication in triage).  The Flow RN will “depart to other area” on the tracking board if nothing else is needed (and ensure the patient gets to UCC on time if their appointment is soon), or the pain reassessment nurse will do the same once their pain has been reassessed (within 60 min of oral medication administration). 
* If the patient is < 25 and going to PED (YAFT), do not mark “OK for UCC”

===If the patient is OOP after full registration at UCC===
* UCC Registration staff will message the PAC supervisor to '''reactivate the ED FIN''' 
** UCC Registration will '''move the patient to "AWR"''' with a note in the “RN Comments” column “from UCC”
* UCC RN will call the RME Charge RN at x66950 to notify them the patient was OOP and will be returning to the ED
** UCC will escort the patient to Triage 2 (same process as other patients transferred from UCC to ED);  if Triage 2 team unavailable, UCC will handoff patient to the RME Charge RN
* The triage physician/APP who initially saw the patient (reference MSE Note) should be notified so they can place any additional necessary orders (as only pain medications were ordered for patients going to UCC)
** RN
*** If pain medications were given on the initial visit, perform the pain reassessment
** Physician/APP
*** If the initial MSE physician/APP is no longer on shift, the next available triage physician/APP can review the previous MSE note (quickly examine the patient if necessary) and place appropriate orders
* Patient to RME Registration for full registration
* Patient to Tasking for initiation of orders
* Place in R4/5 for pain reassessment if additional pain medications are needed 
* Patient to AWR or FastTrack when bed available or ready for DC

===Cheat Sheets===
* ED to UCC (RN role)
** Completing check-in process at UCC; if no appt available, 
may be sent back to ED (expected 6-hour wait for care)
** Triage Note
** If pain med given, call UCC RN x65110/11/15/18
with Name, MRN, DOB, med, reassessment time
** Give patient green map, circle at top if med was given
** If escort needed, USA x66973 (backup = x66950 for NA)
** Patient to RED LINE at UCC Check-in Window
** Remove from Orchid – “Transfer to Other Service Area”
** If patient returns from UCC:
*** Quick Triage (“refer to initial triage note from today”)
*** Pain reassessment if medication was given in ED
*** Have original Physician/APP place additional orders
*** Send patient to Tasking (reg completed at UCC)

* ED to UCC (Physician/APP role)
** Complete MSE/note
*** UCC Eligible:  
**** Any ESI 4/5 without EMC (does not requires immediate medical attention to avoid severe harm, permanent disability, or death) and is stable to be discharged without additional stabilizing treatment prior to being seen at the UCC within the next 24 hours
*** “DHS/DHS Eligible” on Banner Bar
*** Place order for pain medication if needed
*** Place “Discharge Patient” order in Orchid
*** If patient returns from UCC, discontinue the “discharge” order and place orders for Tasking