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

Authors:

Bradley Chappell