Harbor:ED follow-up options: Difference between revisions

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==Patients who CANNOT follow up at Harbor==
==FOLLOW-UP==
*There is an orange OOP icon (“out of plan/out of county”). Think “oops!, my patient cannot follow up here at Harbor.” Only patients with the green DHS icon are eligible for follow up within the DHS system.
*MyHealthWayLA has outside resources for PMD follow up.
**Refer to PMD or HMO plan
**If patient wants to switch to Harbor network, they must call their insurance company to change it.
**Some instances, patient's PMD/insurance can give pre-authorization for care at Harbor.


==Patients who CAN follow up at Harbor==
===<big><big>[https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]</big></big>===
===Primary care or non-urgent (>2 weeks) specialty care referrals===


*Non Urgent PMD referrals: use CCC for all patients with >=1 chronic ambulatory-care sensitive condition, i.e. COPD, asthma, htn, HL, DM, CAD, CHF, seizure disorder. Those that don't quality due to not having an ambulatory care sensitive condition, please give CHC list (each clerk's desk has them). See the separate CCC section for details. If your patient is homeless, can consider scheduling into Lomita FM so patient can leave with appointment in hand.
===Primary Care Clinics===
* For anyone who is DHS eligible and not assigned; at any DHS clinic, including hospital-based clinics, regardless of how many chronic conditions (0 to multiple) that they have  (Dr. D. Hsieh 1/23/19)
*[[File:DHS Primary Care Clinics.pdf|thumb]]


*DHS empaneled patients requiring non-urgent specialty care–→ Can refer via CCC, or have them ask their PMD to place an E-Consult. If you’re referring for hernia repair, please document the hernia size and location, and pt’s BMI and comorbidities. If you’re referring for elective cholecystectomy, please document the pt’s BMI and comorbidities.


===Urgent Specialty Care referrals (less than 2 weeks):===
===DHS Patient with Empanelled Provider===
*DHS empaneled/LA County uninsured: call specialty service for approval and have clerk book in Orchid
# Instruct the patient to follow up with their empaneled provider
*Limited expedited workup clinic spots and Gyn Urgent Care spots
# Use the 'communicate' tool to send a message to the empaneled provider listed in the banner bar
*Out of county uninsured: have the patient call 2-1-1 from anywhere in California for a call center/clearinghouse for health services.
# Write a brief message explaining why and when the patient needs follow up
*Insured patients: Refer to their own health plan
# Their empaneled provider can initiate e-consults if applicable
# Starting Feb 2018, empaneled providers will automatically be notified of ED visits but you can still message them with any specific concerns


==Specialty Clinics We Can Book Into After Consultation==
===Urgent <2 Week Specialty Follow-up for DHS or MHLA Patients===
'''Get name of approving physician'''
Write the following items in the follow up field for clerk to book:
*Ortho
# Name of approving doctor
*Derm
# Time frame (I.e., 2 days, 1 week, etc.)  
*ENT
# Reason for urgent follow up
**Discharge the patient from the ED to ophtho, ENT clinic, Ortho Cast Room, 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)
*Trauma/Acute Care Surgery
*Cardiology
*Urology
*Ophtho


==Other Clinics We Can Book into ==
===Discharging Patients Direct to Specialty Clinic===
*Expedited Work Up (see separate section on criteria)
* In certain situations, patients can (and should) be discharged to a specialty clinic for same/next business day visit (Ophtho, ENT, Cast room, OMFS, etc.).  This is considered a continuation of ED care to stabilize their presenting emergent medical condition. Once care is completed in the clinic, the patient should NOT be sent back to the ED.
*72 HRS STRESS TEST
* This allows consultants to evaluate and treat patients in their clinic as opposed to coming to the ED
*Anticoagulation clinic (write ok to overbook per Dr. French)
* '''The patient CAN BE "OUT OF PLAN" FOR THIS SERVICE as is considered part of ED visit'''
*Sport Medicine
* Process/Troubleshooting: 
*NEVER REFER TO PAIN CLINIC!
# Get agreement from consultant
# Must be seen in 24 hours or next business day (if weekend)
# ED Care should be complete
# Must be during normal clinic operating hours and clinic must be open (Cast room is open until 11 pm 7 days a week)
# ED physician should note time and place for patient to follow-up on the ED discharge paperwork, and make sure patient takes paperwork with them to clinic
# ED Clerk schedules the visit as appropriate
# If any issues, consider attending involvement and/or contact Dr. Roger Lewis via cell.


==Scheduling Outpt Studies==
Dir AED, Chair EM, Dir OPS 9/20/17
*Stress Testing
**Order in Orchid "Treadmill Stress Test", clerk will schedule - check with them to see if we have slots open


*US or MRI
===[[Harbor:ED follow-up options|Follow up]] in CCC===
**In general: DON’T DO IT!
<big>'''''REFER TO [https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]'''''</big>
**Try and have the service requesting the study order it


*Outpt Labs
<big>'''LAB/SYMPTOM FOLLOW-UP''': DOES NOT INCLUDE Urine cultures or STI follow up anymore (goes to "Lab Follow-Up-HAR"). Otherwise, can be any patient seen in the Adult ED, regardless of insurance or empanelment.</big>
**Okay in certain circumstances
*Be specific re: f/u time frame when filling out the form
**ONLY if patient will have a follow-up appointment in one of our clinics within 1-2 days of the lab draw!
*CCC reviews requests in a few business days. No abnormal lab result review after hours or on weekends or holidays
*If you think a patient needs an urgent face to face evaluation, have them go to the Urgent Care if DHS eligible.
*CCC will only call patient if an abnormal result needs to be addressed. (Example: Urine culture shows antibiotic needs to be switched).
*For pediatric patients, do not select PVCC/CCC, rather select PED


==Continuity Care Clinic (CCC)==
<big>'''Bridge to PMD: only DHS patients discharged home, not empaneled on banner bar, not MHLA/OOP.'''</big>
{{Harbor follow up}}
*Only for DHS patients without other resources.
*Only for patient's dispositioned HOME.
**If unassigned MediCal, patient can go to The Patient Advocate office, Main Hospital PCDC 108 1-B1, Mon and Wed 8a-430p, x4409 to establish empanelment at Harbor
**If the patient was dispositioned to Obs/CORE/Psych ED/Admitted, they cannot go to CCC.
**Don’t place the ‘ED Post Visit Plan’ form for CCC referral until you’ve decided the patient’s final disposition. If you place it too early, have to cancel or ‘place in error’ the referral form.
*Need at least one Ambulatory Care Sensitive Condition (ACSC)
**Chronic conditions which appropriate outpt care prevents inpt admission and/or complications.
**Asthma, CHF, Cancer, CVA, ESRD, CF, DM, HIV/AIDS, IBD, Heart Dz, HTN, HL, Neuromuscular dz, Psych d/o, CKD, RA, Sz d/o, Substance abuse d/o, Specified debilitating conditions
**CCC will work to transition to primary care via NERF submission
**'''<big>If they want to switch to Harbor UCLA or have problems with their health plan</big>''', they can call their own insurance plan. For MHLA patients, they can also contact MHLA directly and request the change if eligible.
**'''<big>If they are Out of Country/County, and now reside in LA County</big>''', they can go to Registration PCDC Rm 108, 1st floor main hospital, ext 8101 to change their address by bringing any mail or DMV record.
 
<big>'''E-consult for non-urgent specialty referral - DHS patient discharged home, not empaneled, not MHLA'''</big>
*Only non-urgent/not time-sensitive. If request for specialty visit <2wks, do not use CCC. Instead, call specialty consultant to schedule appt prior to d/c
**Appointment Service Center contacts patient to schedule the appointment around 2 weeks just to start arranging follow up.
**If e-consult submitted already, patient can call ASC themselves to schedule their appointment 855-521-1718.
*'''CHOLE patients:  need formal RUQ US''' prior to clinic evaluating patient;  please include BMI and smoking status in chart. 
*If outside records available, ask ED clerk to copy and upload to ORCHID
 
'''<big>How to submit CCC referral</big>'''
*Fill out ‘ED Post Visit Plan’ in the Depart Process. Select ‘PVCC/CCC – Har’ and fill out the form to put patient on their tracking list. Make sure there is a correct phone number.
*Forgot to do the form, patient off the tracking board? 
**Highlight your patient on the “HAR Look Up” track
**Click ‘Modify Event’ on the toolbar.
**Then, manually request BOTH:
***‘Post Visit PVCC’ for adult patients or ‘Post Visit Peds’ for peds patients,
***‘Post Visit Follow Up’ event to put the patient on the follow up track.
***If you placed the form by accident, cancel the PVCC form or place ‘in error’ notification. Example, if patient doesn’t get discharged from ED, need to cancel PVCC form if placed earlier.
*Finish your ED Provider Note. CCC can’t do anything until you’ve finished your note!
 
 
{{Harbor Opiate Withdrawal/MAT/BUP}}
 
===[[Harbor:ED follow-up options|Follow up]] In Other Clinics===
<big>'''For DHS eligible patients only: Clerk will book into appointment slot, or if unable, will place a request into the scheduling queue for Patient Access Center/Call Center x1220 to take over. Patients can also call 310-222-1200 to schedule appointments (Rather than calling the clinic directly)'''.</big>
====Anticoagulation (Coumadin) Clinic====
*Book without consultant approval
* Book at 7d post initiation of anticoagulation
*M-F 8am-4pm Ext. 5159, M-F after hours 4-9pm pager 9995, S- Sun 8am-8pm Pager 9995
 
====Breast Diagnostic Center (Radiology)====
*Book without consultant approval
** Call for deep abscess to arrange US and I&D for same or next-day f/up
** '''Send here for imaging and biopsy of mass/malignancy.'''  This Is a Radiology Imaging Center. NOT the same as Breast Surgery Clinic
*See above section on Breast Abscess https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis
*See above section for Breast Mass  https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Breast_mass.2Fmalignancy
 
====Breast Surgery Clinic====
*needs e-Consult via PCP
*If patient does not have PCP, consider CCC (if patient qualifies) to start eConsult process
**If urgent needs follow up <2 weeks for DHS patient, consider consult to breast surgery resident (through Trauma surgery) from the ED
*See above section on Breast Abscess https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis
**For patients with a breast abscess that is s/p bedside I&D, recurrent breast abscess/mastitis, already diagnosed breast cancer, persistent palpable masses (also need biopsy by Radiology's Breast Diagnostic Center as above)
*See above section for Breast Mass https://www.wikem.org/wiki/Harbor:Operations_manual#Breast_mass.2Fmalignancy
** '''Only directly refer here if the patient has imaging and path results; otherwise, they need referral to the Breast Diagnostic Center first'''
 
====CARDIOLOGY====
*Daytime: Talk to CORE during the day, Afterhours: Talk to C-team Night fellow (listed on MedHub)
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up. (Cards will message their Mariedel Morales and Sheila Walters IC, the Cardiology clerks to book).
 
====DERM====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====ENT====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====Expedited Work-up Clinic (EWC)====
*The Expedited Workup Clinic (EWC) is an option for patients who are stable but require close outpatient follow-up for further diagnostic evaluation (ex. uncharacterized mass, anemia, etc). These are patients that would have been admitted otherwise, but are clinically stable. The EWC is for patients who do not have a primary care provider and must have reliable contact information.
*Clerk books WITHOUT consultant approval
*HAR CCC Rm 4, every Monday afternoons.
*Must have reliable contact info, confirm phone number and address
 
*Ideal candidates are those patients that would be admitted in the absence of EWC, and '''do not have a primary care provider.''' Patients must have '''reliable contact information to attend this clinic.'''
*'''If no slots available, send a message to CCC to book the patient.'''
*Clinical criteria:
#'''New onset ascites:''' New diagnosis and first presentation of ascites. Requires paracentesis performed in ED to rule out infection, SAAG >1.1, transaminases < 3x normal, rapid HIV, CBC, lipase, CMP. No referral for therapeutic paracentesis alone, No evidence of pancreatitis or biliary obstruction.
#'''Anemia (Hgb< 8g/dL on initial presentation):''' Requires CBC, peripheral smear, CMP, rapid HIV, ECG, CXR, type and screen No evidence of pancytopenia, HIV, leukemia, active GI/GU bleeding, or evidence of hemolysis. Patients with suspected gynecologic etiology should be referred to the GYN service. Post transfusion CBC required.
#'''Weight loss, unexplained >10% within 1 month or >15% in 6 months:'''  Requires CBC, CMP, ECG, CXR, rapid HIV. Patients with prior imaging must have actual images or be instructed to retrieve images  prior to clinic appointment.
#'''Undiagnosed mass ''(excluding primary breast, brain, renal, head and neck masses)'':''' Requires results or radiographic imaging to confirm presence of mass. Patients with prior imaging must have actual images or be instructed to retrieve imaging prior to clinic appointment. Send CBC, CMP, PT/INR, HIV on all patients.
#'''New onset pleural effusion:''' Requires thoracentesis, CMP, CBC, serum amylase, LDH, and pleural fluid analysis (predominant lymphocytic effusion or high suspicion for Tuberculosis must be admitted). Chest CT only if immediately clinically indicated (ie. suspicion for pulmonary embolism).
 
*Patient is stable (T< 38.3c, HR<100, RR <24, BP >110/50, BP <180/110, pulse ox >92% on room air, oriented x 4)
*Able to be seen in 2-10 business days without significant risk
*No ACTIVE co-morbidities (ie infection, CAD, CHF, stroke, metastatic cancer, renal failure, dyspnea).
 
====GYN====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====Gyn UCC====
* Book without consultant approval
* '''3-4d f/up for ALL DHS PID patients''' (cervical motion tenderness or adnexal tenderness, empirically treated)
 
====Nephrology Clinic====
*For non-dialysis patients only: Don’t need Nephrology fellow approval per Sharon Adler, MD, Chief, Division of Nephrology and Hypertension, 7/28/17)
**3 slots a week specifically earmarked for ED use for Thursday morning Nephrology clinic (GN, diabetes, other CKD)
**2 “Discharge” slots for the Friday afternoon Hypertension (complex/resistant HTN, HTN with CKD, stones, PCKD, SLE)
====Neurosurgery====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====OB====
*For new pregnancy: discharge patient with OB clinic intake phone number (310-222-7200) so they can schedule appointment
====ONCOLOGY====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up.
*Newly diagnosed, metastatic cancer - discuss with oncology fellow p7862
 
====OPHTHO====
*Book without consultant approval for next day follow up for orbital wall fractures w/o orbital injury concerns, ok per Dr. Prasad, Division Chief
*All other cases: Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====ORTHO====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====PEDIATRICS====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====Pediatric Adolescent Clinic====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====Pediatric Cardiology====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====PLASTIC SURGERY====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====PULMONARY====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====RHEUM====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====SURGERY====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
====UROLOGY====
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
 
====72 HRS STRESS TEST====
Place order in ORCHID for "CV Treadmill Stress Test"
*If test is abnormal, cardiology follow up automatically generated by HEART station.
*If test is normal, no notification occurs, other than typical follow up. If you want someone to follow up on the result, consider messaging empaneled PCP or refer to CCC.
*Outpatient P-MIBI Nuclear stress has to be arranged by CORE
 
=== FOLLOW-UP FOR OUT-OF-COUNTY/OUT-OF-COUNTRY (OOC) PATIENTS===
Per DHS Policy 516.1, Out of County/Country Patients who need an urgent follow-up for an emergency medical condition may be provided such follow-up at Harbor
#Emergent Conditions:
##Places health in serious jeopardy
##Threatens serious impairment to bodily functions
##Threatens serious dysfunction to any organ or body part
#If they are from a county close by - consider referring them to their home county. Call 2-1-1 social services hotline.
#Do not arrange follow-up for NON-EMERGENT/URGENT issues
 
*If patient is no longer Out of Country/County, they can go to Registration Rm 108, 1st floor main hospital), ext 8101 to change their address.
 
Dir AED, Dir OPS, DHS Policy 516.1 9/25/17


==See Also==
==See Also==

Revision as of 19:06, 25 January 2020

FOLLOW-UP

ED follow up flow chart

Primary Care Clinics

  • For anyone who is DHS eligible and not assigned; at any DHS clinic, including hospital-based clinics, regardless of how many chronic conditions (0 to multiple) that they have (Dr. D. Hsieh 1/23/19)
  • File:DHS Primary Care Clinics.pdf


DHS Patient with Empanelled Provider

  1. Instruct the patient to follow up with their empaneled provider
  2. Use the 'communicate' tool to send a message to the empaneled provider listed in the banner bar
  3. Write a brief message explaining why and when the patient needs follow up
  4. Their empaneled provider can initiate e-consults if applicable
  5. Starting Feb 2018, empaneled providers will automatically be notified of ED visits but you can still message them with any specific concerns

Urgent <2 Week Specialty Follow-up for DHS or MHLA Patients

Write the following items in the follow up field for clerk to book:

  1. Name of approving doctor
  2. Time frame (I.e., 2 days, 1 week, etc.)
  3. Reason for urgent follow up

Discharging Patients Direct to Specialty Clinic

  • In certain situations, patients can (and should) be discharged to a specialty clinic for same/next business day visit (Ophtho, ENT, Cast room, OMFS, etc.). This is considered a continuation of ED care to stabilize their presenting emergent medical condition. Once care is completed in the clinic, the patient should NOT be sent back to the ED.
  • This allows consultants to evaluate and treat patients in their clinic as opposed to coming to the ED
  • The patient CAN BE "OUT OF PLAN" FOR THIS SERVICE as is considered part of ED visit
  • Process/Troubleshooting:
  1. Get agreement from consultant
  2. Must be seen in 24 hours or next business day (if weekend)
  3. ED Care should be complete
  4. Must be during normal clinic operating hours and clinic must be open (Cast room is open until 11 pm 7 days a week)
  5. ED physician should note time and place for patient to follow-up on the ED discharge paperwork, and make sure patient takes paperwork with them to clinic
  6. ED Clerk schedules the visit as appropriate
  7. If any issues, consider attending involvement and/or contact Dr. Roger Lewis via cell.

Dir AED, Chair EM, Dir OPS 9/20/17

Follow up in CCC

REFER TO ED follow up flow chart

LAB/SYMPTOM FOLLOW-UP: DOES NOT INCLUDE Urine cultures or STI follow up anymore (goes to "Lab Follow-Up-HAR"). Otherwise, can be any patient seen in the Adult ED, regardless of insurance or empanelment.

  • Be specific re: f/u time frame when filling out the form
  • CCC reviews requests in a few business days. No abnormal lab result review after hours or on weekends or holidays
  • If you think a patient needs an urgent face to face evaluation, have them go to the Urgent Care if DHS eligible.
  • CCC will only call patient if an abnormal result needs to be addressed. (Example: Urine culture shows antibiotic needs to be switched).
  • For pediatric patients, do not select PVCC/CCC, rather select PED

Bridge to PMD: only DHS patients discharged home, not empaneled on banner bar, not MHLA/OOP.

  • Only for DHS patients without other resources.
  • Only for patient's dispositioned HOME.
    • If unassigned MediCal, patient can go to The Patient Advocate office, Main Hospital PCDC 108 1-B1, Mon and Wed 8a-430p, x4409 to establish empanelment at Harbor
    • If the patient was dispositioned to Obs/CORE/Psych ED/Admitted, they cannot go to CCC.
    • Don’t place the ‘ED Post Visit Plan’ form for CCC referral until you’ve decided the patient’s final disposition. If you place it too early, have to cancel or ‘place in error’ the referral form.
  • Need at least one Ambulatory Care Sensitive Condition (ACSC)
    • Chronic conditions which appropriate outpt care prevents inpt admission and/or complications.
    • Asthma, CHF, Cancer, CVA, ESRD, CF, DM, HIV/AIDS, IBD, Heart Dz, HTN, HL, Neuromuscular dz, Psych d/o, CKD, RA, Sz d/o, Substance abuse d/o, Specified debilitating conditions
    • CCC will work to transition to primary care via NERF submission
    • If they want to switch to Harbor UCLA or have problems with their health plan, they can call their own insurance plan. For MHLA patients, they can also contact MHLA directly and request the change if eligible.
    • If they are Out of Country/County, and now reside in LA County, they can go to Registration PCDC Rm 108, 1st floor main hospital, ext 8101 to change their address by bringing any mail or DMV record.

E-consult for non-urgent specialty referral - DHS patient discharged home, not empaneled, not MHLA

  • Only non-urgent/not time-sensitive. If request for specialty visit <2wks, do not use CCC. Instead, call specialty consultant to schedule appt prior to d/c
    • Appointment Service Center contacts patient to schedule the appointment around 2 weeks just to start arranging follow up.
    • If e-consult submitted already, patient can call ASC themselves to schedule their appointment 855-521-1718.
  • CHOLE patients: need formal RUQ US prior to clinic evaluating patient; please include BMI and smoking status in chart.
  • If outside records available, ask ED clerk to copy and upload to ORCHID

How to submit CCC referral

  • Fill out ‘ED Post Visit Plan’ in the Depart Process. Select ‘PVCC/CCC – Har’ and fill out the form to put patient on their tracking list. Make sure there is a correct phone number.
  • Forgot to do the form, patient off the tracking board?
    • Highlight your patient on the “HAR Look Up” track
    • Click ‘Modify Event’ on the toolbar.
    • Then, manually request BOTH:
      • ‘Post Visit PVCC’ for adult patients or ‘Post Visit Peds’ for peds patients,
      • ‘Post Visit Follow Up’ event to put the patient on the follow up track.
      • If you placed the form by accident, cancel the PVCC form or place ‘in error’ notification. Example, if patient doesn’t get discharged from ED, need to cancel PVCC form if placed earlier.
  • Finish your ED Provider Note. CCC can’t do anything until you’ve finished your note!


MAT/BUP/Opiate Withdrawal

  • Please refer all DHS patients with substance use disorder (SUD) started on medication assisted treatment (MAT) to PVCC/CCC – Har for enrollment in Dr. Brown's addiction clinic
    • In the "For referral, specify need" box: "MAT for opiate/alcohol dependency"

Qualifying patients

  • Active withdrawal or post-overdose: start buprenorphine in ED via buprenorphine protocol
  • Not in active withdrawal but with opioid use disorder: rx for home start using home initiation protocol
  • Patients with chronic pain and opioid dependence with PMD at Harbor: message PMD AND Christopher Brown AND Gloria Sanchez to link patient to Harbor SUD clinics
  • For pregnant patients - once the primary complaint is addressed (or if primary complaint is pregnant and opiate use disorder/withdrawal), if patient has confirmed IUP please send to OB triage for initiation of Suboxone during pregnancy

Consult Whole Person Care for ALL patients started on or prescribed buprenorphine in the ED

Narcan Distribution from ED

  • Available for any patients that meet criteria for Narcan distribution and would benefit from distribution
    • In Code White cabinet in purple doc box, next to the adult airway cabinet, requires key from either senior resident phones or either attending phones
    • Please initial to log the distribution on the clipboard attached, no PHI is required
  • All patients distributed Narcan also need it prescribed to the pharmacy for tracking purposes
  • Please document as you otherwise would for prescribing Narcan, with the addition of .ednaloxonegiven in your note, which can soon be replaced by .naloxoneEDdistribution
  • Thank you for helping!

MAT Provider Consultation Line

  • DHS on-call providers available to help initiate MAT for patients with alcohol and/or opioid use disorder
    • (213) 288-9090
    • 8a-12a, 7 days per week
  • Flier: Mat Consult Line.pdf

BUP/MAT Treatment and Discharge Pathway

Patient Discharge Handout

BUP Home Initiation

Patient MAT/Buprenorphine Follow Up Options

Insurance Clinic Hours
DHS Empaneled and DHS Eligible (not Harbor Family Medicine) Primary Care & Diagnostic Center (PCDC) - Basement Clinic C

1000 W. Carson St
Torrance, CA 90502
(424) 306-4546

Schedule as "HAR PC MAT New" or

Walk-In: Monday AM or Thursday AM
For questions, please message Chris O. Brown, MD via ORCHID/Outlook

DHS Empaneled and DHS Eligible Lomita Clinic

1430 W Lomita Blvd, 2nd Fl
Harbor City, CA 90710
(310) 602-2600
(424) 306-4193 - SUD Counselor

Walk-In: Tuesday AM or Friday AM

For questions, please message Gloria Sanchez, MD via ORCHID/Outlook

DHS Empaneled, DHS Eligible, MyHealthLA, Uninsured (No OOP) LAC+USC Urgent Care

2051 Marengo St, 2nd Floor
Los Angeles, CA 90033
(323) 409-1000

Walk-In:

Tuesday-Thursday & Saturday
8am-7pm

All Patients Tarzana Treatment Center

5190 Atlantic Blvd
Long Beach, CA 90805
(818) 654-3933

Walk-In:

24/7

All patients can call the Substance Abuse Service Hotline 24/7 for more help (844) 804-7500

Follow up In Other Clinics

For DHS eligible patients only: Clerk will book into appointment slot, or if unable, will place a request into the scheduling queue for Patient Access Center/Call Center x1220 to take over. Patients can also call 310-222-1200 to schedule appointments (Rather than calling the clinic directly).

Anticoagulation (Coumadin) Clinic

  • Book without consultant approval
  • Book at 7d post initiation of anticoagulation
  • M-F 8am-4pm Ext. 5159, M-F after hours 4-9pm pager 9995, S- Sun 8am-8pm Pager 9995

Breast Diagnostic Center (Radiology)

Breast Surgery Clinic

  • needs e-Consult via PCP
  • If patient does not have PCP, consider CCC (if patient qualifies) to start eConsult process
    • If urgent needs follow up <2 weeks for DHS patient, consider consult to breast surgery resident (through Trauma surgery) from the ED
  • See above section on Breast Abscess https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis
    • For patients with a breast abscess that is s/p bedside I&D, recurrent breast abscess/mastitis, already diagnosed breast cancer, persistent palpable masses (also need biopsy by Radiology's Breast Diagnostic Center as above)
  • See above section for Breast Mass https://www.wikem.org/wiki/Harbor:Operations_manual#Breast_mass.2Fmalignancy
    • Only directly refer here if the patient has imaging and path results; otherwise, they need referral to the Breast Diagnostic Center first

CARDIOLOGY

  • Daytime: Talk to CORE during the day, Afterhours: Talk to C-team Night fellow (listed on MedHub)
  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up. (Cards will message their Mariedel Morales and Sheila Walters IC, the Cardiology clerks to book).

DERM

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

ENT

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

Expedited Work-up Clinic (EWC)

  • The Expedited Workup Clinic (EWC) is an option for patients who are stable but require close outpatient follow-up for further diagnostic evaluation (ex. uncharacterized mass, anemia, etc). These are patients that would have been admitted otherwise, but are clinically stable. The EWC is for patients who do not have a primary care provider and must have reliable contact information.
  • Clerk books WITHOUT consultant approval
  • HAR CCC Rm 4, every Monday afternoons.
  • Must have reliable contact info, confirm phone number and address
  • Ideal candidates are those patients that would be admitted in the absence of EWC, and do not have a primary care provider. Patients must have reliable contact information to attend this clinic.
  • If no slots available, send a message to CCC to book the patient.
  • Clinical criteria:
  1. New onset ascites: New diagnosis and first presentation of ascites. Requires paracentesis performed in ED to rule out infection, SAAG >1.1, transaminases < 3x normal, rapid HIV, CBC, lipase, CMP. No referral for therapeutic paracentesis alone, No evidence of pancreatitis or biliary obstruction.
  2. Anemia (Hgb< 8g/dL on initial presentation): Requires CBC, peripheral smear, CMP, rapid HIV, ECG, CXR, type and screen No evidence of pancytopenia, HIV, leukemia, active GI/GU bleeding, or evidence of hemolysis. Patients with suspected gynecologic etiology should be referred to the GYN service. Post transfusion CBC required.
  3. Weight loss, unexplained >10% within 1 month or >15% in 6 months: Requires CBC, CMP, ECG, CXR, rapid HIV. Patients with prior imaging must have actual images or be instructed to retrieve images prior to clinic appointment.
  4. Undiagnosed mass (excluding primary breast, brain, renal, head and neck masses): Requires results or radiographic imaging to confirm presence of mass. Patients with prior imaging must have actual images or be instructed to retrieve imaging prior to clinic appointment. Send CBC, CMP, PT/INR, HIV on all patients.
  5. New onset pleural effusion: Requires thoracentesis, CMP, CBC, serum amylase, LDH, and pleural fluid analysis (predominant lymphocytic effusion or high suspicion for Tuberculosis must be admitted). Chest CT only if immediately clinically indicated (ie. suspicion for pulmonary embolism).
  • Patient is stable (T< 38.3c, HR<100, RR <24, BP >110/50, BP <180/110, pulse ox >92% on room air, oriented x 4)
  • Able to be seen in 2-10 business days without significant risk
  • No ACTIVE co-morbidities (ie infection, CAD, CHF, stroke, metastatic cancer, renal failure, dyspnea).

GYN

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

Gyn UCC

  • Book without consultant approval
  • 3-4d f/up for ALL DHS PID patients (cervical motion tenderness or adnexal tenderness, empirically treated)

Nephrology Clinic

  • For non-dialysis patients only: Don’t need Nephrology fellow approval per Sharon Adler, MD, Chief, Division of Nephrology and Hypertension, 7/28/17)
    • 3 slots a week specifically earmarked for ED use for Thursday morning Nephrology clinic (GN, diabetes, other CKD)
    • 2 “Discharge” slots for the Friday afternoon Hypertension (complex/resistant HTN, HTN with CKD, stones, PCKD, SLE)

Neurosurgery

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

OB

  • For new pregnancy: discharge patient with OB clinic intake phone number (310-222-7200) so they can schedule appointment

ONCOLOGY

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up.
  • Newly diagnosed, metastatic cancer - discuss with oncology fellow p7862

OPHTHO

  • Book without consultant approval for next day follow up for orbital wall fractures w/o orbital injury concerns, ok per Dr. Prasad, Division Chief
  • All other cases: Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

ORTHO

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

PEDIATRICS

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

Pediatric Adolescent Clinic

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

Pediatric Cardiology

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

PLASTIC SURGERY

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

PULMONARY

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

RHEUM

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

SURGERY

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

UROLOGY

  • Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up

72 HRS STRESS TEST

Place order in ORCHID for "CV Treadmill Stress Test"

  • If test is abnormal, cardiology follow up automatically generated by HEART station.
  • If test is normal, no notification occurs, other than typical follow up. If you want someone to follow up on the result, consider messaging empaneled PCP or refer to CCC.
  • Outpatient P-MIBI Nuclear stress has to be arranged by CORE

FOLLOW-UP FOR OUT-OF-COUNTY/OUT-OF-COUNTRY (OOC) PATIENTS

Per DHS Policy 516.1, Out of County/Country Patients who need an urgent follow-up for an emergency medical condition may be provided such follow-up at Harbor

  1. Emergent Conditions:
    1. Places health in serious jeopardy
    2. Threatens serious impairment to bodily functions
    3. Threatens serious dysfunction to any organ or body part
  2. If they are from a county close by - consider referring them to their home county. Call 2-1-1 social services hotline.
  3. Do not arrange follow-up for NON-EMERGENT/URGENT issues
  • If patient is no longer Out of Country/County, they can go to Registration Rm 108, 1st floor main hospital), ext 8101 to change their address.

Dir AED, Dir OPS, DHS Policy 516.1 9/25/17

See Also