Harbor:Options for follow-up (peds)

Start

First determine whether the patient can be seen at Harbor

• Patients who have LA Care DHS 644 or Health Net DHS 615 are followed by us and can be seen in our clinics
• Patients with no insurance at all, straight or emergency Medi-Cal, or CCS can be seen in our clinics

"OOP" (Out-of-plan)

The patient cannot come to any Harbor clinics, except for subspecialty clinics as a continuation of their ED visit within 24 hours of the ED visit

• Subspecialty service care as a continuation of the ED visit within 24 hours of the ED visit
  • For patients seeing subspecialty service immediately (eg ortho in cast room, ophtho/ENT in clinic), discharge the patient from the ED to go to appropriate location
  • Patients seeing the subspecialty service the next morning (still within 24 hours of ED visit) can be discharged home to follow up in the appropriate subspecialty clinic
  • OOP patients may NOT follow up in subspecialty clinics > 24 hours after the ED visit, even ortho patients that have been casted
• An orange sheet with the OOP patient's health plan information and primary physician assigned / contact information is available from registration
  • Look for it in the accordian file near the PED clerk
  • If not there, ask the registration staff for it
  • You can give this sheet to the patient / family
• The OOP primary physician and contact information will also be automatically printed on the patient's discharge paperwork in many cases
• If subspecialist referral is needed, consider giving the patient/parent a copy of the subspecialist's consult note to take to their PMD
• For patients with imaging studies, ask the nurse/clerk to please have them placed on a CD to give to the patient/parent

Can be seen at Harbor

• For subspecialty clinics where the patient needs to be seen in < 2 weeks
  • Page the appropriate subspecialist for approval (get their name)
    • Put in for the appointment using "Follow-up Date" on the Depart Process: free text the clinic needed, put the approving doctor in the comments section
    • Click "Schedule Follow-up Appointment" to make the star appear on the track so the clerk knows to schedule an appointment
• For subspecialty clinics where the patient can wait > 2 weeks
  • Use the ED Post Visit Plan, click Referral, and type in what type of referral is needed and why
    • The pediatric NPs will put in an eConsult
  • For patients needing an MRI first and then subspecialty referral, get the patient a primary care provider to order the MRI (see below for how)
• For short term follow-up of a specific condition (eg wound check, asthma or pneumonia recheck, suture removal), can use Acute Care Follow-up Clinic
  • Put in for the appointment using "Follow-up Date" on the Depart Process: free text "Peds Acute Care Follow-up Clinic"
    • Click the "Schedule Follow-Up Appointment" pencil during the discharge process to put a star on the track, letting the clerk know to make an appointment
  • Patients can be seen in follow-up clinic Monday through Friday (non-Holiday) during the day
• For pregnant patients
  • OB intake appointment can be given to establish OB care if there are no significant medical issues
    • This will NOT be an MD/NP visit; it will only be an administrative intake visit
  • Else, call OB/Gyn for f/u or send to Gyn urgent care within a few days
• For regular pediatric well-child care
  • Family medicine has given us a few slots per day to assign kids to their clinic
    • They would like actual kids though - please don't put adults seen in PED into these slots
  • If not OOP, clerk can book Pediatric Primary Care Clinic 1st Appointment
    • Do not give 20 year olds this type of appointment
• For adults 18yo and older needing primary physician, go to pemsource.org, Harbor only page, Patient handouts, and print the appropriate page of "PCP Referral 18-20 years)" handout