Harbor:Pediatric ED (main): Difference between revisions

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''See [[Harbor:Main|Adult ED]] for the main adult Harbor page.''
''See [[Harbor:Main|Adult ED]] for the main adult Harbor page.''
==Background==
''This is the main page for Harbor-UCLA ''Pediatric'' ED; See [Harbor:Main|Adult ED]] for the main Harbor Adult ED page.''
This is the main page for Harbor-UCLA Pediatric ED.
 
==Message of the Moment==
Check here for the latest in Pediatric ED administrative news!


==General Administrative==
==General Administrative==
*[[Harbor:Peds ED schedule and sick backup plans|Schedule and sick backup plans]]
*[[Harbor:Peds ED schedule and sick backup plans|Schedule and sick backup plans]]
*[[Harbor:Peds ED follow-up track information|Follow-up track information]]
*[[Harbor:Peds ED follow-up track information|Follow-up track information]]
**Place lab checks for any lab that will not result during the patient's visit
***Examples: urine/throat/wound cultures, urine GC/Chlamydia, pertussis PCR, thyroid function tests
***Use the ED Post Visit Plan on the Depart Process
****Get a phone number where the patient can be reached best
****Click Lab/Radiology follow-up
****Specify result to be checked and plan
****If you don't do this while the patient is still on the track, you need to do an extra step: Events->Request Event->ED Post Visit Peds, or else they will not be on the f/u track (HAR Follow Up)
**You can order phone f/u calls to check on patient's symptoms
***Do as for lab check above, except check Symptom Follow-up and specify what symptoms to ask about
**If a patient can be seen at Harbor (not OOP), you can put in for a referral
***Do as for lab check above, except check Referral and specify what referral is needed
**Phone and lab checks will be done by NPs on Mon, Tues, Thurs, Fri and by the 10am-7:30pm intern / resident on Wed, Sat, Sun, holidays
**Detailed instructions are in a binder labeled "F/U Instructions" in the PED, and on Pemsource.org on the Harbor page


==Managing your Patient==
==Managing your Patient==
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***Remember that pediatric medications are often dosed on a per kg basis
***Remember that pediatric medications are often dosed on a per kg basis
***Cerner does not automatically stop at a maximum dose, so check that you are not ordering more than an adult dose
***Cerner does not automatically stop at a maximum dose, so check that you are not ordering more than an adult dose
**Separate Saline Lock order is not needed if you are ordering an IV medication or IV bolus
***If you are ordering a blood draw and want an IV also, must separately order saline lock
*[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
*[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
*[[Harbor:Ultrasound Approval List|Ultrasound approval list]]
*[[Harbor:Ultrasound Approval List|Ultrasound approval list]]
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===Documenting===
===Documenting===
*[[Harbor:Attending documentation|Attending documentation]]
*[[Harbor:Attending documentation|Attending documentation]]
*[[Harbor: Consenting a Patient|Consenting a Patient]]
*[[Harbor:Consenting a patient|Consenting a Patient]]


===Procedures===
===Procedures===
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*[[Harbor:Paging|Paging consults]]
*[[Harbor:Paging|Paging consults]]
*[[Harbor:Consultation of subspecialists (peds)|Consultation of subspecialists]]
*[[Harbor:Consultation of subspecialists (peds)|Consultation of subspecialists]]
**For pediatric patients (< 21 years old), pediatric medical subspecialists are consulted
*[[Harbor:Equipment and supplies (peds)|Equipment and supplies]]
***MedHub Harbor call schedule (link from PEMsource.org Harbor only page), choose Pediatrics
***Peds Department Pagers also posted in PED docbox and linked on PEMsource.org Harbor only page
**For surgical subspecialties (eg Ortho, ENT, Ophtho, Neurosurg, Plastics, Derm, Urology, OMFS), use the on-call schedule as for adult patients except:
***General surgery, consult resident on Pediatric surgery pager 6105 Mon-Fri 8am-5pm
****Otherwise, consult Trauma surgery
**For Psychiatry
***Mon-Fri 8am-4pm call the Child and Adolescent Psychiatry fellow
****MedHub Harbor call schedule (link from PEMsource.org Harbor only page), choose Psychiatry -> Child and Adolescent Psychiatry
***After hours and on weekends and holidays, call Psych ED for Psychiatry resident on call x3144


===Special patient types===
===Special patient types===
*For patients followed in a pediatric subspecialty clinic, particularly Hematology-Oncology & Cardiology, call the subspecialist on call to notify them of the patient's ED visit
*[[Harbor:PED psych patients|Psychiatric patients]]


==Patient Disposition==
==Patient Disposition==
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*[[Harbor:Paging|Paging consultants]]
*[[Harbor:Paging|Paging consultants]]
*[[Harbor:Pediatric admission guidelines|Admission guidelines]]
*[[Harbor:Pediatric admission guidelines|Admission guidelines]]
**Patient age
***Pediatric ward and PICU admit patients up to age 21 years and 364 days old
****If another service is asking to admit an adult patient aged 18-21 years, state that the patient should be admitted to pediatrics with the other service consulting
***Patients < 1 month old with no respiratory symptoms or diarrhea may potentially be admitted to NICU or nursery
****Discuss with admitting nursery (x2311) or NICU (x2340) resident
**ED attendings have admitting privileges
***Admissions will be accepted by pediatric residents regardless
****Pediatric residents, in conjunction with their attending, may evaluate the patient and perform an immediate discharge if they so desire
**ED attendings determine, with admitting resident input, the appropriate location: ward, step-down, PICU
**ED should have done all of the following prior to contacting the admitting resident
***Complete necessary work-up and treatment for stabilization that should occur acutely in the ED
***Make sure with Utilization Review that the patient can be admitted to Harbor
****If the attending says patient is not stable for transfer, then the patient will be admitted
****The Interqual icon does NOT have to be green prior to contacting admitting resident IF ED staff are sure the patient will be admitted to Harbor
**Peds does not have isolation areas, so if patient needs isolation (eg active TB, meningococcemia, measles, varicella), discuss with admitting resident
***Patient may need to be admitted to an adult area and followed by peds, or transferred
**Contacting admitting resident
***Harbor MedHub call schedule (linked from PEMsource.org Harbor only page)
***Protected time
****Weekdays 6:45am-7:30am
****Weekends 7:45am-8:30am
****All evenings 7pm-7:30pm
***For ward and step-down
****Mon-Fri 7a-7p: Pediatrics Ward Senior Admit resident (will be Gold or Blue, depending on which team is admitting)
****Mon-Fri 7p-7a: Pediatrics PM Ward Senior
****Sat-Sun 24 hours: Pediatrics Ward Senior Admit resident
****If unsure, can call Peds ward at x2333 to ask for admitting resident
***For PICU
****Mon-Fri 7a-7p: Pediatrics PICU
****Mon-Fri 7p-7a: Pediatrics PM PICU
****Sat-Sun 24 hours: Pediatrics PM PICU
****If unsure, can call PICU at x2480 to ask for admitting resident
***If you forget to ask, the Attending name for Ward Blue or Gold team, or PICU will be listed on MedHub
**After admission
***Once the ED staff puts in a "Request for Admit" order, the pediatrics team is managing the patient
****ED staff should have all ED orders in and completed prior to putting in Request for Admit
*****Make sure nursing has had a chance to complete ED orders prior to putting in Request for Admit
***As part of their admission orders, pediatric residents may order additional labs, imaging, etc.
****These do NOT need to be done in the ED prior to the patient going upstairs
****Ultrasounds can be difficult to obtain from inpatient, so attempt to get any ultrasounds done prior to leaving ED
***For any delays in patient going upstairs, have nursing contact Patient Flow


===Other===
===Other===
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==[[Harbor:Disaster info|Disaster]]==
==[[Harbor:Disaster info|Disaster]]==
*[[Harbor:Disaster info|General disaster info]]
*[[Harbor:Disaster info|General disaster info]]
*[[Harbor:Surge plan]]
*[[Harbor:Surge plan|Surge Plan]]
*[[Harbor:Ebola|Suspected Ebola protocol]]
*[[Harbor:Ebola|Suspected Ebola protocol]]


==See Also==
==See Also==
*[[Harbor:Main]]
*[[Harbor:Main]]
*[[Harbor:Operations manual]]


[[Category:Admin]]
[[Category:Admin]]

Latest revision as of 16:58, 30 December 2019

See Adult ED for the main adult Harbor page. This is the main page for Harbor-UCLA Pediatric ED; See [Harbor:Main|Adult ED]] for the main Harbor Adult ED page.

Message of the Moment

Check here for the latest in Pediatric ED administrative news!

General Administrative

Managing your Patient

Ordering

  • Use the Peds ED tab on Cerner Place Orders for PED quick orders
    • For medication orders
      • Remember that pediatric medications are often dosed on a per kg basis
      • Cerner does not automatically stop at a maximum dose, so check that you are not ordering more than an adult dose
    • Separate Saline Lock order is not needed if you are ordering an IV medication or IV bolus
      • If you are ordering a blood draw and want an IV also, must separately order saline lock
  • Ordering a Formal Ultrasound
  • Ultrasound approval list
  • Ordering a CT
  • Ordering Blood Products
  • Ordering antibiotics

Documenting

Procedures

Finding Things

Special patient types

  • For patients followed in a pediatric subspecialty clinic, particularly Hematology-Oncology & Cardiology, call the subspecialist on call to notify them of the patient's ED visit
  • Psychiatric patients

Patient Disposition

Discharging a Patient

Admitting a patient

Other

Disaster

See Also

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