View source for Harbor: Surge Team Checklist

==Surge Team==
* Starting Oct 1, 2025:  1p - 10p, Monday through Saturday
** Purpose: provide additional coverage during peak patient arrivals, focus on dispo of completed ESI 3 (MidTrack) patients from AWR, lead the FastTrack team, and be a resource to triage providers
** '''Expectations'''
*** APP:  2pt/hr of ESI 4 & 5
**** 6a NP (1p-6p = 10 pts)
**** 8a NP (currently short-staffed)
**** 9a NP (variable shift to triage if >1-hr wait = 10 pts)
**** Noon NP (6p-11p = 10 pts)
**** APPs to staff at least 2 cases with attending (any ESI 3's or ESI 4/5 for education/feedback [do not send these charts])
*** R4:  2pt/hr of ESI 3 & 4 (independent dispo - staff if needed) - 17 pts
*** R2:  1.5pt/hr of ESI 3 & 4 (staffing with attending) – 13 pts 
*** FM R3:  1pt/hr of ESI 4/5 (staffing with attending) – 9 pts 
*** Attendings - '''The Flowmaster'''
**** '''Contact AOD with any real-time issue'''
**** '''Surge Attending must continuously review AWR patients for completed WR workups and mark as TEAL'''
***** This should be performed throughout your shift to aid your team with appropriate patient selection
***** Don't get bogged down with admissions (these should be assigned to teams - you can note this in the RN Comments column - "AED room")
**** Talk to the PED attending (x66910) to see if some of the TEAL ESI 3's can go to PED
**** Ensure UCC appropriate patients are flagged for UCC
***** Right click "Events" column then click "Ok for UCC" box and save
**** Call RME charge x66950 if there are open rooms/chairs
**** '''Consider assisting with triage if wait for MSE >1 hour''' (or direct NP or resident from Surge Team to assist)
***** Are there enough resources?  If only 2 triage nurses, call the OCN at x66930
***** If there are 3 triage nurses and only 2 triage providers, redirect someone from the Surge Team to help triage until ~30min door to provider time
***** If you want to help MSE:
****** Brief patient interview and focused exam
****** Click on MSE note, mark as "triage provider", "stable to wait", ESI (2=unstable VS, 3=multiple resources, 4=1 resource, 5=no resources), document brief HPI, focused PE
****** Place pertinent orders, avoids IV's or IV meds (only place IV if needed for CT)
**** Answer any workup questions from Triage NP/R3, approve CT/MRI when needed
**** See patients independently if time permits (esp on Saturday when no EM residents), short-staffed NP or resident
**** Co-sign all resident notes; write independent notes at your discretion

* '''Room utilization'''
** Non-surge hours:
*** R42 - ESI 5 (NP) - no resources needed, just DC
*** R8 (R9-12) = purple/green teams
*** X-hall = FT NP (teams if short staffed)
*** P8-11 = PED EM resident (staff with purple/green attending if pediatric attending or PEM fellow)
** During SURGE shift
*** R42 - ESI 5 (NP) - no resources needed, just DC
*** '''R8 (R9-12) = R4'''
*** '''X-hall = FT NP + R2'''
*** '''P8-11 = FMR3''''
*** If short-staffed
**** R8 (R9-12) = R4/R2
**** P8-11 = FMR3/NP

* Shift Timeline:
** 1p - meet in rounding room (plan to move to old XR waiting room as 4th doc box once approved for use by CDPH)
*** Pick up phones from green doc box (if it is not in the wood box, try calling it)
*** 5-min all-staff '''RME huddle''' to determine staffing/rooms, identify roles, and get registration updates on UCC
**** '''Consider starting a group TEAMS chat''' with provider and nursing team to facilitate communication
*** Utilize FastTrack filter in Orchid
*** EM R2 & FM3 start seeing patients
*** EM R4 and attending utilize '''RME + triage''' filter to review patients in AWR
**** '''Orange - likely DC but pending completion of workup'''
**** '''Teal - appear ready for DC'''
**** Label WR patients as "hall" vs "room" in RN comments column to help guide nursing
** 1:30p - R4 starts seeing patients, attending staff EM R2 & FM R3 cases (check in with NP periodically to see if they need any assistance)
** 3:00p - purple screens/wraps up, '''Green takes runs''', surge only helps if >3 ALS/Crit med/TTA
** 4p - '''Monday - Friday''': migrate to purple doc box as needed;  '''surge R4 takes crit med/TTA 1, surge R2 takes ALS/TTA2''' (note should be written so it is a true pick-up, not just “screened”);  Green screens BLS 
** 5p - sign out any ALS/crit med/TTA to purple ('''senior to senior, junior to junior'''); migrate to green doc box as needed; '''Purple takes runs''', green rounds, surge only helps if >3 ALS/Crit med/TTA 
** 6p - back to rounding room
** 7p - Attending checks in with new RME Charge for staffing updates
** 9:15p - selectively pick up new patients (minimize sign-outs);  if you are not going to be able to see them, the '''SURGE Attending should assign these to Purple/Green'''
** 9:45p: Sign out remaining patients to green (quick pickups) and purple (longer pickups), finish charting
** 10p: 
*** 5-min medical topic talk (include NPs) from an interesting case from the shift
*** Phone back to green doc box (charge if needed)
*** Attending completes resident and APP (ARE WE CREATING A FORM LIKE THE STUDENT ONES) evals

* '''Phone #'s''' (keep physician phones in Green doc box)
** Triage Resident x66923
** 6a NP x66924 --> '''FT 1pm - 6pm''' - independent dispo
** 9a NP 66925
** '''Surge Attending x66991'''
** '''Surge FM R3 x66992''' - staff with attending (R4 as backup)
** '''Surge R4 x66926''' - independent dispo (direct staffing as needed)
** '''Surge R2 x66927''' - staff with attending (R4 as backup)
** 8a NP x66928 - currently short-staffed, but FT 8a - 8p when present - independent dispo
** Noon NP x66929 - '''FT 6p - 11p''' - independent dispo