Harbor:Operations manual

Pre-hospital/Surge Plans

Ambulance Triage

• Screening EMS Patients

Surge Criteria and Plan

• Harbor Surge Plan/Disasters
• Harbor disaster plan

Orchid Downtime

• ORCHID Downtime

ID: Flu, Hepatitis, Ebola

• Infectious Disease Threats

Radiology

• MRI Specs
• CT Specs
• Formal & ED Ultrasounds
• STAT MRI
• Example text for a discrepancy e-mail

EQUIPMENT

• Equipment (AED/RME)
• Equipment (peds)

Ordering DME

• Durable Medical Equipment (DME)

IA/Exposures

Occupational Exposure

• Industrial or On-the-Job Accidents (IA)

Sexual Assult/STI Exposure

• Sexual Assult/STI Exposure

Patient Disposition

F/up Flowchart

• https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]

Law Enforcement Escort

• Prescribing

Other

• Deceased patients
• Transferring a patient
  • Transferring to psych ER

ADMISSIONS

Admission Policy

• Admitting a patient

OBS & CORE

• Observation placement
• CORE placement

Admission Guidelines

• Admission and consultation guidelines (policy 312)
  • Right level of care
  • Internal Medicine Admission Template
  • C-Team Admissions
  • Who Goes to Family Medicine
• Post-admission management/Orders on Admitted Patients

Boarding Patients Sent from Clinic

Just a reminder to the seniors in the Emergency Department running the board: the correct procedure for patients admitted from clinic who do not need a monitored bed, especially when the clinic is closing, is for the clinic to contact the patient flow facilitator to assist in locating a bed in the hospital, and only contact the emergency department to board the patient if the flow facilitator cannot make other arrangements.

Monitored bed patients can be sent from the clinic to the emergency department to board when we are out of monitored beds. If it does not sound like the patient needs a monitored bed, please talk to the ED attending.

(Dir. OPS, February 03, 2015)

Insurance Problems

1. For issues with insurance, refer patients to the CA Dept of Managed Healthcare: https://www.dmhc.ca.gov/

Physicians

STEMI Activation

• ECG STEMI screening

Scheduled Dialysis Patients in ED

1. The router will place them on the pre-arrivals each AM (M/W/F)
2. HD times should be 5-9a and 930-130p
3. They will receive a MSE at triage – if they decline the MSE and only want their scheduled HD, please document that “the patient declined a MSE and no emergent medical condition exists at this time” in the MSE note and we are done from the ED perspective
4. If the patient appears unstable, please discuss with one of the AED attendings to determine if they need to be on an AED team or simply need dialysis with a call to the nephrologist for urgent evaluation.
5. Once the MSE is performed, they will be taken to one of our HD rooms – preferentially Gold 29, then RME 19, then Acute 15 (likely a max of 2 rooms at a time).
6. They will be cared for by the nephrologist (typically Dr. Anuja Shah) who will place the discharge orders (so these patients should NOT be placed on AED teams).
7. If for some reason Dr. Shah is unable to evaluate the patient prior to discharge, the FastTrack NP (not resident) will briefly evaluate the patient when ready for discharge - documenting vitals, heart, lung, and lower extremity exam, and page Dr. Shah to clear for dispo and subsequently print the discharge instructions (“HEMODIALYSIS” patient education).
8. The NP will forward the chart to Dr. Shah, not ED R4 or Attending.

Chappell 12-1-17

ED Procedure Videos

• LP
• Para ...

LEGAL

Harbor:Legal

See Also

• Harbor: Main
• Harbor:Code STEMI