Harbor:ED follow-up options

For Patient who CANNOT follow up at Harbor

• There is now a pink OOP icon (“out of plan/out of county”). Think “oops!, my patient cannot f/u here at Harbor.”
  • Refer to PMD or HMO plan

For patients who CAN follow up at Harbor

Primary care or non-urgent (>2 weeks) specialty care referrals

• DHS empaneled patients –-> call their PMD for apt
• Uninsured patients
  • New r/o CA or homeless with moderate-severe complexity --> Lomita FM (ED clerk to book)
• Moderate-severe complexity
  • Long Beach, Wilmington, Lomita Urgent Cares for walk-in.
  • Note that Hubert Humphrey and MLK to go live with Orchid in February, so sending them there is no longer a good option!
• Low complexity –-> CHC

Urgent Specialty Care referrals (less than 2 weeks):

• DHS empaneled/LA County uninsured: call specialty service for approval and have clerk book in Orchid
• Out of county uninsured: have the patient call 2-1-1 from anywhere in California for a call center/clearinghouse for health services.
• Insured patients: Refer to their own health plan

ED Follow-Up

1. Breast Clinic
2. Coumadin Clinic
3. Expedited Workup Clinic
4. GI Referrals
5. Neurology Referrals
6. Rheum Clinic (See form)
7. Elective Surgery Referrals
8. Urology Referrals

• Make sure you clarify with the specialist what kind of form is needed. Many times, the intrafacility form has replaced the specific specialty forms. And ALWAYS get the name of your consultant!

Specialty Clinics We Can Book Into After Consultation

• Trauma
• Ortho (have a form but often not asked for)
• Derm
• Ophtho (same day appointments)
  • Discharge the patient from the ED to ophtho clinic, unless you feel they have ongoing medical issues that require them coming back to ED
  • If they require admission, can be admitted from there or sent back to ED
• GYN UC (often all booked so have to call)
• Cardiology
• Family Medicine Sports Clinic (Fridays)—only SPORTS related injuries

NEVER REFER TO PAIN CLINIC!

Scheduling Outpt Studies

• Stress Testing
  • Form in Affinity
    • Fill out and print to heart station
    • Patient Charting
    • Click Chart Assessment Tab
    • Click RECORD
    • Click on Exercise Treadmill
    • Complete form entirely
    • SAVE AS FINAL
    • Print to HEART
    • Clerk makes appointment and PUTS order in computer
    • Can only schedule treadmills on an urgent basis (<72 hrs); if you want a MIBI or stress ECHO can use same process but it will be a mail-out

• US or MRI
  • In general: DON’T DO IT!
  • Never do it for DVT: US bounces all of these back
  • In select cases in which a specific follow-up clinic requests a test, you can order it via Affitnity, similar to above, with the following caveat:
    • DO NOT PUT YOUR NAME OR ER AS THE ORDERING PHYSICIAN OR DEPARTMENT. PERIOD

• Outpt Labs
  • Okay in certain circumstances
  • ONLY if patient will have a follow-up appointment in one of our clinics within 1-2 days of the lab draw!
  • How to do it?
    • Get lab draw slip from clerk
    • Clerk can order the outpatient labs that you want
    • Recommend you don’t do this unless you talked to somebody who is willing to have their name go on the lab slip and follow-up the results