Harbor:ED follow-up options: Difference between revisions
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<big>'''''REFER TO | <big>'''''REFER TO | ||
*[[:File: | *[[:File:AED followup flowchart 8-23-21.pdf]] | ||
*[[:File:PED followup flowchart | *[[:File:PED followup flowchart 8-23-21.pdf]] '''''</big> | ||
*Outpatient Follow up is based on patient’s insurance network | |||
*'''Out of Plan (OOP)''', means the patient has Non-DHS insurance network, Private insurance, Other Medi-Cal HMOs, or could be out of County/Country. | |||
* '''MHLA''', MyHealthLA, are > 18yo, “uninsurable,” community clinic PCP that can e-consult to get subspecialty & inpatient care through DHS | |||
* '''DHS''' means LA County Department of Health Services network eligible | |||
*'''Patient Relations Representatives (PRR)''' in ED 7 days a week; | |||
** Call Registration for PRR who can help empanel into DHS or change empanelment/network in real time. During business hours, can also send patient to Patient Relations Office in Rm 1-B-1. | |||
===[[Same/Next Day Specialty Clinic Follow up]]=== | |||
*Sending or discharging directly to specialty clinic | |||
=== | ===RESULTS/SYMPTOM FOLLOW-UP=== | ||
* | *OOP, MHLA, DHS can all have phone follow up for results (labs or imaging), symptoms checks | ||
*[[Adults results/symptom phone follow up]] (Lab Follow-up - HAR) | |||
* | *[[Peds results/symptom phone follow up]] (Peds - HAR/USC) | ||
* | *Follow-up of outpatient labs/imaging | ||
* | **Any imaging/labs requested by a consultant in the ED that will NOT be resulted during the patient's stay in the ED should be ordered by the consultant making the request. | ||
**Follow-up of outpatient tests can be either performed by the consultant OR by the CCC | |||
=== | ===[[OOP follow up options]]=== | ||
===DHS eligible patients=== | |||
*[[DHS-Eligible patient needing Primary Care]] | |||
===DHS | ===[[Urgent Specialty Follow-up for DHS or MHLA Patients]]=== | ||
* Within 4 weeks or less | |||
* Place the "ED Request for Specialty Appointment" order | |||
** As of 7/25/23, no longer done by clerks | |||
** If no approval is needed per the ED to Specialty Clinic Referral Guidance document, write your name (ordering provider) in the approving provider field. | |||
** When specialty approval is required per the document, place the approving specialty provider’s name in the field. | |||
* After a conversation with a consulting specialist, their specific recommendation supersedes any timeframe listed in the ED to Specialty Clinic Referral Guidance document. | |||
=== | ===[[NERF]]=== | ||
=== | ===[[Patient wants to switch to Harbor]]=== | ||
===[[Instructions for clerk requesting/booking an appointment]]=== | |||
===Pediatrics CCS Follow up=== | ===[[Pediatrics CCS Follow up]]=== | ||
===[[ | ===[[CCC]]=== | ||
*Bridges DHS eligible patients to primary care until empaneled (still need to NERF) | |||
* | *Refer all DHS patients with substance use disorder (SUD) started on medication assisted treatment (MAT) to CCC for enrollment in Dr. Brown's addiction clinic | ||
* | |||
=== | ===[[Harbor:Opiate Withdrawal/MAT/BUP|MAT/BUP/Opiate Withdrawal]]=== | ||
=== | ===[[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 to take over. Patients can also call PAC to schedule appointments (Rather than calling the clinic directly)'''</big> | |||
==== | ====DHS Patients Lost to Follow-up==== | ||
* | * If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange for routine follow-up for the patient: | ||
** HAR-OP-Anesthesiology: Pain Management-Clerical | |||
** HAR-OP-Cardiology: Anticoagulation-Clerical | |||
** HAR-OP-Cardiology: General Cardiology-Clerical | |||
** HAR-OP-Cardiology: HFDMP-Clerical | |||
** HAR-OP-Cardiology: Pulmonary Hypertension-Clerical | |||
** HAR-OP-Dermatology-Clerical | |||
** HAR-OP-Endocrine: Diabetes-Clerical | |||
** HAR-OP-Endocrine: General-Clerical | |||
** HAR-OP-Endocrine: Pituitary-Clerical | |||
** HAR-OP-Endocrine: Thyroid-Clerical | |||
** HAR-OP-Endocrinology: Diabetes Specialty-Clerical | |||
** HAR-OP-Endocrinology: General Endocrinology-Clerical | |||
** HAR-OP-Gastroenterology-Clerical | |||
** HAR-OP-Hematology/Oncology-Clerical | |||
** HAR-OP-Infectious Disease-Clerical | |||
** HAR-OP-Neurology-Clerical | |||
** HAR-OP-OB/Gyn: Gyn Oncology-Clerical | |||
** HAR-OP-OB/Gyn: Gyn Urgent Care-Clerical | |||
** HAR-OP-OB/Gyn: Reproductive Endo/Infertility-Clerical | |||
** HAR-OP-OB/Gyn: UroGyn-Clerical | |||
** HAR-OP-OB/Gyn: Women's Health-Clerical | |||
** HAR-OP-Pulmonology-Clerical | |||
** HAR-OP-Renal: General Nephrology-Clerical | |||
** HAR-OP-Renal: Renal Hypertension-Clerical | |||
** HAR-OP-Renal: Renal Transplant - Clerical | |||
** HAR-OP-Rheumatology-Clerical | |||
** HAR-OP-Surgery: Bariatric Surgery-Clerical | |||
** HAR-OP-Surgery: Breast Surgery-Clerical | |||
** HAR-OP-Surgery: Cardiothoracic Surgery-Clerical | |||
** HAR-OP-Surgery: Colorectal Surgery-Clerical | |||
** HAR-OP-Surgery: Dentistry-Clerical | |||
** HAR-OP-Surgery: Neurosurgery-Clerical | |||
** HAR-OP-Surgery: Ophthalmology-Clerical | |||
** HAR-OP-Surgery: Oral and Maxillofacial Surgery-Clerical | |||
** HAR-OP-Surgery: Orthopedic Surgery-Clerical | |||
** HAR-OP-Surgery: Otolaryngology-Clerical | |||
** HAR-OP-Surgery: Plastic Surgery-Clerical | |||
** HAR-OP-Surgery: Surgical Oncology-Clerical | |||
** HAR-OP-Surgery: Trauma Surgery-Clerical | |||
** HAR-OP-Surgery: Urology-Clerical | |||
** HAR-OP-Surgery: Vascular Surgery-Clerical | |||
** HAR-OP-Pediatrics: Allergy/Asthma-Clerical | |||
** HAR-OP-Pediatrics : Cardiology - Clerical | |||
** HAR-OP-Pediatrics : Child Development - Clerical | |||
** HAR-OP-Pediatrics : Craniofacial - Clerical | |||
** HAR-OP-Pediatrics : Diabetes - Clerical | |||
** HAR-OP-Pediatrics : Endocrinology - Clerical | |||
** HAR-OP-Pediatrics : Failure to Thrive - Clerical | |||
** HAR-OP-Pediatrics : Gastroenterology - Clerical | |||
** HAR-OP-Pediatrics : Hematology - Clerical | |||
** HAR-OP-Pediatrics : High Risk Infant - Clerical | |||
** HAR-OP-Pediatrics : Immunology - Clerical | |||
** HAR-OP-Pediatrics : Infectious Disease - Clerical | |||
** HAR-OP-Pediatrics : Medical Genetics - Clerical | |||
** HAR-OP-Pediatrics : Nephrology - Clerical | |||
** HAR-OP-Pediatrics : Neurology - Clerical | |||
** HAR-OP-Pediatrics : Nursery - Clerical | |||
** HAR-OP-Pediatrics : Oncology - Clerical | |||
** HAR-OP-Pediatrics : Rheumatology - Clerical | |||
** HAR-OP-Pediatrics : Surgery - Clerical | |||
====Anticoagulation (Coumadin) Clinic==== | ====Anticoagulation (Coumadin) Clinic==== | ||
*Book without consultant approval | * ED Request for Specialty Appointment: ANTICOAGULATION (Return) | ||
* | ** Book without consultant approval | ||
*M-F 8am-4pm Ext. 5159, M-F after hours 4-9pm pager 9995, | ** Patient must be an established patient in the anticoagulation clinic seen in the last 12 months | ||
** Request the specific date for 7 days post initiation of anticoagulation | |||
* M-F 8am-4pm Ext. 5159, M-F after hours 4-9pm pager 9995, Sat-Sun 8am-8pm Pager 9995 | |||
====Breast Diagnostic Center (Radiology)==== | ====Breast Diagnostic Center (Radiology)==== | ||
* | *BDC is a Radiology Imaging Center for mammograms and ultrasounds. NOT the same as Breast Surgery Clinic | ||
**Breast Abscess - needing ultrasound guided needle aspiration as per https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis | |||
**Breast Abscess - | |||
**Breast Mass - need imaging and biopsy of mass/malignancy as per https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Breast_mass.2Fmalignancy | **Breast Mass - need imaging and biopsy of mass/malignancy as per https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Breast_mass.2Fmalignancy | ||
====Breast Surgery Clinic==== | ====Breast Surgery Clinic==== | ||
* | *'''Please consult the appropriate surgical service on any patient presenting to the ED within the 30-day post-operative period, even if for something seemingly unrelated to the surgery.''' | ||
* | ** During the daytime (7a-7p), you should always directly call Breast/Surg Onc (x9397) | ||
**If urgent | ** After hours (7p – 7a), these teams are covered by trauma. | ||
** If you inadvertently call trauma for these services during the daytime, they have been instructed to have you directly page the appropriate service. | |||
*'''e-Consult via PCP''' | |||
**If the patient needs urgent follow-up <2 weeks for DHS patient, consider consult to breast surgery resident (through Trauma surgery) from the ED | |||
*'''Only for Breast Abscess in DHS patients s/p bedside I&D, recurrent breast abscess/mastitis''', as per https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis | *'''Only for Breast Abscess in DHS patients s/p bedside I&D, recurrent breast abscess/mastitis''', as per https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis | ||
*'''Only for Breast Mass in DHS patient with imaging and tissue biopsy results already done''' https://www.wikem.org/wiki/Harbor:Operations_manual#Breast_mass.2Fmalignancy | *'''Only for Breast Mass in DHS patient with imaging and tissue biopsy results already done''' https://www.wikem.org/wiki/Harbor:Operations_manual#Breast_mass.2Fmalignancy | ||
** Otherwise, they need referral to the Breast Diagnostic Center (BDC) first | ** Otherwise, they need referral to the Breast Diagnostic Center (BDC) first for imaging | ||
** | ** Patients with metastatic disease - consult (Medical) Oncology from the ED | ||
* If the patient was '''previously followed at Harbor, but was lost to follow-up''', you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Surgery: Breast Surgery-Clerical | |||
====BURN CENTER CLINIC==== | |||
*For DHS eligible patients that need Burn Center follow up at LAC+USC, please call over 24/7 to their Burn Unit Front Desk 323-409-7991 to get an appointment w/in 2-5d depending on your assessment of their acuity. | |||
**Inform the clerk there that you’d like to book a patient into the Burn Eval and Treatment area, which is in 5D in the Inpatient Tower (NOT their A5D Clinic). | |||
**Patients can also call if they have questions about their appointment logistics or want to change their appointment time. | |||
**If you are instructed to call the MAC to make an appointment (this is NOT a transfer), send Dr. Wu an email of the patient’s info, date/time, or use the QR code to submit an admin issue. | |||
*For OOP patients, they can go to Torrance Memorial | |||
====CARDIOLOGY==== | ====CARDIOLOGY==== | ||
*Daytime: Talk to CORE during the day, Afterhours: Talk to C-team Night fellow (listed on MedHub) | *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 Mariedel Morales and Sheila Walters IC, the Cardiology clerks, to book). | *Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up. (Cards will message Mariedel Morales and Sheila Walters IC, the Cardiology clerks, to book). | ||
* For ZioPatch (holter monitor) - message empaneled PCP or CCC for cardiology | * For '''ZioPatch''' (holter monitor) - message empaneled PCP or CCC for cardiology | ||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Cardiology: Anticoagulation-Clerical | |||
** HAR-OP-Cardiology: General Cardiology-Clerical | |||
** HAR-OP-Cardiology: HFDMP-Clerical | |||
=====[[Stress Testing]]===== | |||
==== | ====COLORECTAL Surgery (CRS)==== | ||
*'''Please consult the appropriate surgical service on any patient presenting to the ED within the 30-day post-operative period, even if for something seemingly unrelated to the surgery.''' | |||
* ''' | ** During the daytime (7a-7p), you should always directly call CRS (x0044) | ||
** After hours (7p – 7a), these teams are covered by trauma. | |||
** If you inadvertently call trauma for these services during the daytime, they have been instructed to have you directly page the appropriate service. | |||
** | |||
** | |||
* | * Coming Soon: ED Request for Specialty Appointment order in Orchid | ||
** | ** ONLY if proven colorectal cancer; if unproven cancer, use CCC for EWC | ||
** 2 | *** Book <2 weeks: HAR Colorectal Surgery New (ok to overbook) | ||
** Any other colorectal (non-malignancy) issues, book <4 weeks | |||
** | |||
====DERM==== | ====DERM==== | ||
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | *Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | ||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Dermatology-Clerical | |||
====ENT==== | ====ENT==== | ||
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | *Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | ||
* | * If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | ||
** HAR-OP-Surgery: Otolaryngology-Clerical | |||
====[[Expedited Work-up Clinic (EWC)]]==== | |||
====GYN==== | ====GYN==== | ||
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | *Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | ||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-OB/Gyn: Gyn Oncology-Clerical | |||
** HAR-OP-OB/Gyn: Gyn Urgent Care-Clerical | |||
** HAR-OP-OB/Gyn: Reproductive Endo/Infertility-Clerical | |||
** HAR-OP-OB/Gyn: UroGyn-Clerical | |||
** HAR-OP-OB/Gyn: Women's Health-Clerical | |||
====Gyn UCC==== | ====Gyn UCC==== | ||
* Book without consultant approval | * Book without consultant approval | ||
* '''3-4d f/up for ALL DHS PID patients''' (cervical motion tenderness or adnexal tenderness, empirically treated) | * '''3-4d f/up for ALL DHS PID patients''' (cervical motion tenderness or adnexal tenderness, empirically treated) | ||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-OB/Gyn: Gyn Urgent Care-Clerical | |||
====Interventional Radiology==== | |||
[[Harbor:Urgent_Outpatient_IR|Urgent Outpatient IR]] | |||
====Limb Salvage==== | |||
* Opting out of automatic 30-day automatic f/up consult | |||
* '''Weekdays 7a - 5p''' | |||
** If the patient seems stable for outpatient follow-up: | |||
*** Page limb salvage p0847 | |||
*** After discussion with on-call resident/NP, initiate a TEAMS Chat with: ED attending, ED resident, LS on-call res/NP, LS on-call Attending and send a picture of the involved foot | |||
*** The limb salvage team may respond with appropriate outpatient f/up timeframe or may notify you they will come see the patient in the ED if they feel it is necessary | |||
* '''Afterhours''' (5p - 7a weekdays, weekends, holidays) | |||
** '''Consult trauma if the patient needs surgical evaluation'''; trauma will liaise with limb salvage attending | |||
*** '''Do NOT consult surgery for appointment''' | |||
** '''For appointment only''', can directly contact limb salvage '''OR''' defer to PCP for e-consult to podiatry (at MLK) if appropriate (several weeks to f/up) | |||
*** Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | |||
**** Clerk books directly into HAR Surg VASC -> Podiatry New | |||
A. Wu, MD - ED Director of Ops & A. Miller, DPM - Director of Limb Salvage, Co-Chair of DHS Podiatry Workgroup 3/30/22 | |||
====Nephrology Clinic==== | ====Nephrology Clinic==== | ||
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**3 slots a week specifically earmarked for ED use for Thursday morning Nephrology clinic (GN, diabetes, other CKD) | **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) | **2 “Discharge” slots for the Friday afternoon Hypertension (complex/resistant HTN, HTN with CKD, stones, PCKD, SLE) | ||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Renal: General Nephrology-Clerical | |||
** HAR-OP-Renal: Renal Hypertension-Clerical | |||
** HAR-OP-Renal: Renal Transplant - Clerical | |||
====Neurosurgery==== | ====Neurosurgery==== | ||
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | *Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | ||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Surgery: Neurosurgery-Clerical | |||
====OB==== | ====OB==== | ||
*For new pregnancy: discharge patient with OB clinic intake phone number (424-306-7200) so they can schedule appointment | *For new desired pregnancy w/out anticipated complications: discharge patient with OB clinic intake phone number (424-306-7200) so they can schedule appointment. OB intake is a medical assistant appt, NOT a provider | ||
*For patients with needing serial beta HCGs, patient should follow with Gyn UCC w/in 2-4 days | |||
*For patients considering pregnancy termination or interested in discussing options: discharge patient with general Gyn clinic phone number (424-306-4061), they can request appointment with ROC (reproductive options clinic) | |||
====ONCOLOGY==== | ====ONCOLOGY==== | ||
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*Book without consultant approval for next day follow up for orbital wall fractures w/o orbital injury concerns, ok per Dr. Prasad, Division Chief | *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 | *All other cases: Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | ||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Surgery: Ophthalmology-Clerical | |||
*Ophtho Alphabet soup: | |||
AAU: acute anterior uveitis | |||
AFT: artificial tears | |||
AGV: Ahmed glaucoma valve | |||
ARMD or AMD: age-related macular degeneration | |||
DR: diabetic retinopathy | |||
BRAO: branch retinal artery occlusion | |||
BRVO: branch retinal vein occlusion | |||
BULB: bilateral upper lid blepharoplasty | |||
BVS: borderline visually significant | |||
C/D: cup-to-disc ratio | |||
CEIOL: cataract extraction with insertion of intraocular lens | |||
CME: cystoid macular edema | |||
CRAO: central retinal artery occlusion | |||
CRVO: central retinal vein occlusion | |||
CSME: clinically significant macular edema | |||
CS: cortical spoking (cataract) | |||
CSR: central serous retinopathy | |||
DES: dry eye syndrome | |||
DME: diabetic macular edema | |||
DWC: dense white cataract | |||
ED: epithelial defect | |||
EL: endolaser | |||
ERM: epiretinal membrane | |||
FML: focal macular laser | |||
GS: glaucoma suspect | |||
HST: horseshoe tear | |||
HVF: Humphrey visual field | |||
K: cornea | |||
LH/WC/AFTs: lid hygiene, warm compresses, artificial tears | |||
LPI: laser peripheral iridotomy | |||
MMCR: Muller's muscle conjunctival resection | |||
MP: membrane peel | |||
NCVH: non-clearing vitreous hemorrhage | |||
NPDR: non-proliferative diabetic retinopathy | |||
NS: nuclear sclerosis (cataract) | |||
NTG: normal tension glaucoma | |||
NVG: neovascular glaucoma | |||
NVS: not visually significant | |||
OD: right eye | |||
OHTN: ocular hypertension | |||
OS: left eye | |||
OU: both eyes | |||
POAG: primary open angle glaucoma | |||
PCO: posterior capsular opacity (aka, secondary cataract) | |||
PDR: proliferative diabetic retinopathy | |||
PKP: penetrating keratoplasty (aka corneal transplant) | |||
PPV: pars plana vitrectomy | |||
PRP: pan retinal photocoagulation | |||
PSC: posterior subcapsular cataract | |||
PTG: pterygium | |||
PVD: posterior vitreous detachment | |||
RRD: rhegmatogenous retinal detachment | |||
RT: retinal tear | |||
SB: scleral buckle | |||
SRD: serous retinal detachment | |||
Trab: trabeculectomy | |||
TRD: tractional retinal detachment | |||
VA: visual acuity | |||
VH: vitreous hemorrhage | |||
VS: visually significant | |||
XT: exotropia | |||
YAG cap: YAG capsulotomy | |||
====ORTHO==== | ====ORTHO==== | ||
* | * Starts 5/1/23 | ||
* | * Make sure you're signed off on splinting [https://docs.google.com/spreadsheets/d/1DxK1GWgP3s_bGk4pZ9IFgYLXGuXLTnzJDtUfof_xgic/edit#gid=0 Splinting Guide with Videos] | ||
* [[:File:Ortho consult criteria_Harbor_Final.pdf]] | |||
* Book: depends on injury, see below, with or without consultant approval - write name of approving doctor, time frame, and reason for follow up | |||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Surgery: Orthopedic Surgery-Clerical | |||
* <big>'''Diagnoses Where Orthopedics SHOULD Be Consulted While Patient is in the ED'''</big> | |||
** Consult after XR or other appropriate workup is complete. A single scout film may be the appropriate initial imaging for polytrauma patients with obvious open fracture. | |||
** Incarcerated or non-DHS patients with a diagnosis not found on the “refer to primary care list” may benefit from an orthopedic consult ('''call orthopedics to review if unsure''') to optimize their pre-discharge care and specify timeframe for f/up | |||
** '''Always ask/consult if unsure!''' | |||
*** General: | |||
**** Acute hardware infection | |||
**** Amputation (including subtotal amputation with dysvascular distal part) | |||
**** Chronic osteomyelitis (not related to [[Harbor:Admission_and_consultation_guidelines#Diabetic_Foot_Infections|diabetic foot infection [admission guideline]]]) | |||
**** Compartment syndrome in extremity with fracture | |||
**** Crush injury to the extremity (other than distal tuft) | |||
**** Irreducible fracture or dislocation | |||
**** Laceration or fracture with tendinous or neurovascular injury or symptoms | |||
**** Open fracture of an extremity or impending open fracture (eg, a fracture resulting in skin tenting) | |||
**** Open joint, acute foreign body in joint (consult ortho prior to challenge when high suspicion) | |||
**** Septic joint (ED to perform arthrocentesis outside region of erythema/cellulitis and consult if results are concerning for infection or if unable to aspirate) | |||
**** Any pediatric fractures requiring procedural sedation or surgery | |||
*** Clavicle | |||
**** Clavicle fracture with >5mm displacement | |||
**** AC joint dislocations, types 4-6 | |||
*** Arm/forearm | |||
**** Proximal humerus fracture with displacement | |||
**** Humeral shaft fracture with displacement | |||
**** Any displaced elbow fracture (radial head/neck, distal humerus, olecranon, coronoid) | |||
**** Radius, Ulna, or both bone forearm fracture | |||
**** Distal radius fracture with displacement | |||
*** Wrist/Hand | |||
**** Scaphoid fracture with displacement | |||
**** Acute lunate or perilunate dislocation | |||
**** Flexor tenosynovitis | |||
**** Flexor tendon (palmar hand) injuries | |||
**** Metacarpal fractures with angulation or malrotation or involving multiple MCs | |||
**** Any clenched fist injury, (aka: fight bite) | |||
**** Pressure injection injuries | |||
**** Hand/finger abscesses (excluding paronychia and felon) | |||
**** Reduced DIP/PIP/MCP/CMC dislocations | |||
**** Displaced Phalangeal fractures (other than distal tuft) | |||
**** Nailbed injury with underlying distal phalanx fracture aka Seymour fracture (excluding tuft) | |||
*** Pelvis/thigh/knee | |||
**** Any pelvic fracture | |||
**** All hip and knee dislocations | |||
**** Any femur fracture | |||
**** Patella fractures | |||
**** Acute patellar or quadriceps tendon rupture | |||
**** Multi-ligamentous knee injury (i.e. dislocated knee s/p spontaneous relocation) | |||
*** Leg/ankle | |||
**** Any tibial plateau fracture (please discuss case with ortho prior to ordering any CT) | |||
**** Any tibial shaft fracture | |||
**** Pilon (distal tibia articular impaction) fractures | |||
**** Ankle fractures with displacement (call orthopedics to review XR if unsure) | |||
*** Foot | |||
**** Calcaneus fractures | |||
**** Talus fractures | |||
**** Subtalar dislocations | |||
**** Lisfranc injuries (including 1st and 2nd metatarsal base fractures) | |||
**** Navicular / Cuboid / Cuneiform fractures | |||
*** <big>'''Diagnoses which can be stabilized by ED and REFERRED TO ORTHO Fracture Clinic in 2 weeks unless otherwise specified'''</big> | |||
**** Establishing follow up after outside hospital orthopedic procedure | |||
**** Any fracture with radiographic healing (eg, callus formation) | |||
**** Chronic foreign body in joint | |||
**** Fractured non-unions or malunions | |||
**** Symptomatic orthopedic hardware | |||
*** Shoulder/arm | |||
**** Isolated scapular body fracture | |||
**** Non-displaced/minimally displaced (<5mm midshaft clavicle fracture) | |||
**** AC joint dislocation, types 1-3 (DESCRIBE TYPES 1,2,3) | |||
**** Rotator cuff tear confirmed on MRI (Ortho Sports Clinic, NOT fracture clinic) | |||
**** Nondisplaced proximal humerus fracture (DEGREE OF ANGULATION - sling vs sarmiento?) | |||
*** Elbow/forearm | |||
**** Elbow and shoulder dislocations with no associated fracture that have appropriate imaging confirming reduction** (perfect lateral for the elbow, axillary, Velpeau, or CT for the shoulder). call orthopedics to review XR if unsure | |||
**** Nondisplaced Radial head/neck fracture (splint then Ortho Fracture Clinic - WHY IS THIS LISTED - WHOLE SECTION TO FX CLINIC) | |||
**** Nondisplaced distal radius fracture (splint then '''Ortho Hand Clinic''', NOT Fracture Clinic) | |||
*** Wrist/Hand | |||
**** Occult scaphoid fracture ('''Ortho Hand clinic''', NOT Ortho Fracture Clinic) | |||
**** Non-displaced phalangeal and metacarpal fracture (intrinsic plus splint then refer to clinic; boxer's fractures ok to put into soft dressing then refer to hand clinic - BUDDY TAPE?) | |||
**** Extensor tendon (dorsal hand) injuries (splint then refer to '''Ortho Hand Clinic in <7 days''', NOT Ortho Fracture Clinic) | |||
**** Distal phalanx fracture without nailbed injury (excluding tuft - '''Ortho Hand clinic''', NOT Ortho Fracture Clinic) | |||
**** Distal phalanx fracture with subungual hematoma ('''Ortho Hand Clinic''', NOT Ortho Fracture Clinic) | |||
**** Nailbed injury WITH tuft fracture or without underlying distal phalanx fracture, after ED repair ('''Ortho Hand Clinic''', NOT Ortho Fracture Clinic) ABX IF OPEN? | |||
*** Lower extremity | |||
**** Patellar dislocation s/p relocation (if DHS Empaneled --> Ortho Sports Clinic) | |||
**** Single knee ligament injuries (eg, isolated ACL rupture, meniscal injuries confirmed on outpt MRI - ED MRI not indicated; if DHS Empaneled --> Ortho Sports Clinic) | |||
**** Ankle fractures without displacement subluxation or dislocation (call orthopedics to review XR if unsure) | |||
**** Achilles tendon rupture | |||
**** Fracture of 1st-5th metatarsal shafts | |||
*** <big>'''Diagnoses which can be stabilized by ED and referred to Primary Care (NO ORTHO CONSULT NEEDED)'''</big> | |||
**** Arthritis (osteoarthritis of knee or hip OR inflammatory arthritis [consider rheumatology referral]) | |||
**** Cellulitis | |||
**** Chronic pain | |||
**** Toes: | |||
***** Closed minimally displaced distal phalanx fracture can be treated with buddy tape & hard sole shoe | |||
***** Closed fractures of the lesser (2nd-5th) toe phalanges | |||
**** Deep foreign body in extremity without neurovascular symptoms, fracture, or joint involvement | |||
**** Gunshot wound to extremity without fracture, tendinous, or neurovascular injury (DHS-empaneled patients may be referred to '''Ortho Joint Reconstruction Clinic''') | |||
**** Shoulder impingement | |||
**** Sprains, strains, or contusions (no fracture or joint space widening on radiographs) | |||
**** Tendonitis | |||
====PEDIATRIC ORTHO==== | |||
* Orthopedic conditions that can be managed in the ED with Orthopedic follow-up (must be neurovascular intact; ED clerk can book into orthopedic fracture clinic): | |||
** Radius, ulna, fibula, clavicle, tibia fractures | |||
*** < 5mm displaced and < 15 degrees angulation | |||
*** Pain controlled by oral meds | |||
*** Normal neurovascular status | |||
*** 5 years and older | |||
** Proximal humerus fractures with minimal displacement – place in sling | |||
** Elbow trauma with elevated posterior fat pad, no visible fracture | |||
** Foreign bodies not in bone or joint space | |||
** Salter Harris 1 fractures that are not displaced | |||
** Distal phalanx fractures not involving joint space | |||
** Tuft fractures | |||
* Peds Specifics | |||
** '''OK to Splint; DHS Eligible''' | |||
*** Call ortho and ask for approval to book in clinic the next Tuesday for Pediatric fracture clinic. | |||
*** '''Ortho does not have to see the patient or write a consultation''' | |||
** '''OK to splint; OOP (these will not qualify for CCS)''' | |||
*** D/c patient with copies of films | |||
*** Specific instructions to family to call and get ortho referral | |||
*** Hand-out available with options for families (PMD, Shriner’s, Orthopedic institute) | |||
** '''Patients Seen at OH splinted and referred to Harbor; Call ortho if:''' | |||
*** DHS eligible or empaneled | |||
*** Believe urgent/emergent intervention needed | |||
*** Needs a reduction | |||
*** Patient having difficulty getting into empaneled orthopedist (can give hand-out of other options). | |||
**** Ortho attempts to get CCS and if not able helps get care | |||
***** Ortho and CCS (California Children’s Services) | |||
****** Ortho has hired Anna Contreras ( Daisy) to help get CCS for many of the OOP ortho patients | |||
****** If patient is OOP and ortho requests to see them after they splint or cast send a communication to Anna Contreras through Cerner and she gets back to families within 1 business day. | |||
****** Instructions on each computer in PED doc box | |||
****** If the patient doesn’t qualify for CCS, they will help the family get into their orthopedist | |||
====PEDIATRICS==== | ====PEDIATRICS==== | ||
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | *Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | ||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Pediatrics: Allergy/Asthma-Clerical | |||
** HAR-OP-Pediatrics : Cardiology - Clerical | |||
** HAR-OP-Pediatrics : Child Development - Clerical | |||
** HAR-OP-Pediatrics : Craniofacial - Clerical | |||
** HAR-OP-Pediatrics : Diabetes - Clerical | |||
** HAR-OP-Pediatrics : Endocrinology - Clerical | |||
** HAR-OP-Pediatrics : Failure to Thrive - Clerical | |||
** HAR-OP-Pediatrics : Gastroenterology - Clerical | |||
** HAR-OP-Pediatrics : Hematology - Clerical | |||
** HAR-OP-Pediatrics : High Risk Infant - Clerical | |||
** HAR-OP-Pediatrics : Immunology - Clerical | |||
** HAR-OP-Pediatrics : Infectious Disease - Clerical | |||
** HAR-OP-Pediatrics : Medical Genetics - Clerical | |||
** HAR-OP-Pediatrics : Nephrology - Clerical | |||
** HAR-OP-Pediatrics : Neurology - Clerical | |||
** HAR-OP-Pediatrics : Nursery - Clerical | |||
** HAR-OP-Pediatrics : Oncology - Clerical | |||
** HAR-OP-Pediatrics : Rheumatology - Clerical | |||
** HAR-OP-Pediatrics : Surgery - Clerical | |||
====Pediatric Adolescent Clinic==== | ====Pediatric Adolescent Clinic==== | ||
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | *Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | ||
====Pediatric Cardiology==== | ====Pediatric Cardiology==== | ||
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | *Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | ||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Pediatrics : Cardiology - Clerical | |||
====PLASTIC SURGERY==== | ====PLASTIC SURGERY==== | ||
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | *Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | ||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Surgery: Plastic Surgery-Clerical | |||
====PULMONARY==== | ====PULMONARY==== | ||
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | *Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | ||
Line 252: | Line 511: | ||
====RHEUM==== | ====RHEUM==== | ||
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | *Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | ||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Rheumatology-Clerical | |||
====STI Testing==== | |||
* HAR Positive Care Clinic | |||
* '''DHS empaneled patients only''' 18 y/o and above with high-risk behavior (multiple partners, recurrent STI, etc) | |||
** M-F 8a-4:40p | |||
** x64350 to schedule appt | |||
** can Orchid message Claudia Murray, RN and Vanessa Salguero (clerk) after hours; include reason for referral (eg: “referral for HIV/STI testing in a patient with multiple partners”) | |||
*Offers: | |||
** HIV/STI testing | |||
** HIV Pre Exposure Prophylaxis (PrEP) | |||
====SURGERY==== | ====SURGERY==== | ||
*Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up | *'''Please consult the appropriate surgical service on any patient presenting to the ED within the 30-day post-operative period, even if for something seemingly unrelated to the surgery.''' | ||
** During the daytime (7a-7p), you should always directly call CRS (x0044), Bariatric/MIS (x0802), Pediatric (x6105), Breast/Surg Onc (x9397), and Vascular (x0503 – note the new pager number). | |||
** After hours (7p – 7a), these teams are covered by trauma. | |||
** If you inadvertently call trauma for these services during the daytime, they have been instructed to have you directly page the appropriate service. | |||
*'''Book: with consultant approval''' - write name of approving doctor, time frame, and reason for follow up | |||
* If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Surgery: Bariatric Surgery-Clerical | |||
** HAR-OP-Surgery: Cardiothoracic Surgery-Clerical | |||
** HAR-OP-Surgery: Colorectal Surgery-Clerical | |||
** HAR-OP-Surgery: Plastic Surgery-Clerical | |||
** HAR-OP-Surgery: Surgical Oncology-Clerical | |||
** HAR-OP-Surgery: Trauma Surgery-Clerical | |||
** HAR-OP-Surgery: Vascular Surgery-Clerical | |||
====UROLOGY==== | ====UROLOGY==== | ||
* | * Nephrolithiasis | ||
**'''OK for clerk to book per Dr. Blumberg within 7-10d ''without'' calling urology consultant if meet below criteria''' | |||
*** '''New Dx Nephrolithiasis''' | |||
**** BMP, UA, consider CT for size/location/hydro (US if pregnant), have patients strain urine | |||
*** '''Established Nephrolithiasis''' | |||
**** BMP, UA, bedside US for hydro | |||
* '''CALL urology consult for patients with UTI (infected stone), h/o DM, solitary kidney, pregnancy''' | |||
** PCP follow-up if not already established, then can NERF when appropriate. | |||
** PCP for non-obstructive <5mm stones | |||
* '''Ureteral stent or percutaneous nephrostomy tube pain''' without concern for infection, otherwise uncomplicated course, follow-up in urology clinic in 7 days | |||
** Send Urine culture | |||
*'''Acute urinary retention''' | |||
** '''OK to book in Urology Clinic in 10-14 days WITHOUT consult approval per Dr. Blumberg''' if near baseline Cr, no significant electrolyte derangements, no evidence of post-obstructive diuresis, pain is controlled, and tolerating PO's | |||
** Place foley, send UA, BMP; do NOT sent PSA (falsely elevated with acute retention) | |||
*** If <200ml output, remove catheter | |||
*** If >400ml out, maintain catheter | |||
*** Monitor for post obstructive diuresis. If >200ml/hr for 2 hours (not counting the initial output), consider further observation and IVF resusc | |||
*** Discharge with tamsulosin 0.4 mg daily | |||
* '''All other Urologic conditions:''' book with consultant approval - write name of approving doctor, time frame, and reason for follow up | |||
* '''Epididymitis/orchitis''' just needs PCP f/up | |||
* If the patient has '''previously been followed at Harbor, but was lost to follow-up''', you can message the following clinic-specific message pools and they will arrange follow-up for the patient: | |||
** HAR-OP-Surgery: Urology-Clerical | |||
Per Dr. Blumberg (Urology) & Dr. Wu 2/8/22 | |||
=== FOLLOW-UP FOR OUT-OF-COUNTY/OUT-OF-COUNTRY (OOC) PATIENTS=== | === FOLLOW-UP FOR OUT-OF-COUNTY/OUT-OF-COUNTRY (OOC) PATIENTS=== |
Latest revision as of 05:56, 24 October 2023
REFER TO
- File:AED followup flowchart 8-23-21.pdf
- File:PED followup flowchart 8-23-21.pdf
- Outpatient Follow up is based on patient’s insurance network
- Out of Plan (OOP), means the patient has Non-DHS insurance network, Private insurance, Other Medi-Cal HMOs, or could be out of County/Country.
- MHLA, MyHealthLA, are > 18yo, “uninsurable,” community clinic PCP that can e-consult to get subspecialty & inpatient care through DHS
- DHS means LA County Department of Health Services network eligible
- Patient Relations Representatives (PRR) in ED 7 days a week;
- Call Registration for PRR who can help empanel into DHS or change empanelment/network in real time. During business hours, can also send patient to Patient Relations Office in Rm 1-B-1.
Same/Next Day Specialty Clinic Follow up
- Sending or discharging directly to specialty clinic
RESULTS/SYMPTOM FOLLOW-UP
- OOP, MHLA, DHS can all have phone follow up for results (labs or imaging), symptoms checks
- Adults results/symptom phone follow up (Lab Follow-up - HAR)
- Peds results/symptom phone follow up (Peds - HAR/USC)
- Follow-up of outpatient labs/imaging
- Any imaging/labs requested by a consultant in the ED that will NOT be resulted during the patient's stay in the ED should be ordered by the consultant making the request.
- Follow-up of outpatient tests can be either performed by the consultant OR by the CCC
OOP follow up options
DHS eligible patients
Urgent Specialty Follow-up for DHS or MHLA Patients
- Within 4 weeks or less
- Place the "ED Request for Specialty Appointment" order
- As of 7/25/23, no longer done by clerks
- If no approval is needed per the ED to Specialty Clinic Referral Guidance document, write your name (ordering provider) in the approving provider field.
- When specialty approval is required per the document, place the approving specialty provider’s name in the field.
- After a conversation with a consulting specialist, their specific recommendation supersedes any timeframe listed in the ED to Specialty Clinic Referral Guidance document.
NERF
Patient wants to switch to Harbor
Instructions for clerk requesting/booking an appointment
Pediatrics CCS Follow up
CCC
- Bridges DHS eligible patients to primary care until empaneled (still need to NERF)
- Refer all DHS patients with substance use disorder (SUD) started on medication assisted treatment (MAT) to CCC for enrollment in Dr. Brown's addiction clinic
MAT/BUP/Opiate Withdrawal
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 to take over. Patients can also call PAC to schedule appointments (Rather than calling the clinic directly)
DHS Patients Lost to Follow-up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange for routine follow-up for the patient:
- HAR-OP-Anesthesiology: Pain Management-Clerical
- HAR-OP-Cardiology: Anticoagulation-Clerical
- HAR-OP-Cardiology: General Cardiology-Clerical
- HAR-OP-Cardiology: HFDMP-Clerical
- HAR-OP-Cardiology: Pulmonary Hypertension-Clerical
- HAR-OP-Dermatology-Clerical
- HAR-OP-Endocrine: Diabetes-Clerical
- HAR-OP-Endocrine: General-Clerical
- HAR-OP-Endocrine: Pituitary-Clerical
- HAR-OP-Endocrine: Thyroid-Clerical
- HAR-OP-Endocrinology: Diabetes Specialty-Clerical
- HAR-OP-Endocrinology: General Endocrinology-Clerical
- HAR-OP-Gastroenterology-Clerical
- HAR-OP-Hematology/Oncology-Clerical
- HAR-OP-Infectious Disease-Clerical
- HAR-OP-Neurology-Clerical
- HAR-OP-OB/Gyn: Gyn Oncology-Clerical
- HAR-OP-OB/Gyn: Gyn Urgent Care-Clerical
- HAR-OP-OB/Gyn: Reproductive Endo/Infertility-Clerical
- HAR-OP-OB/Gyn: UroGyn-Clerical
- HAR-OP-OB/Gyn: Women's Health-Clerical
- HAR-OP-Pulmonology-Clerical
- HAR-OP-Renal: General Nephrology-Clerical
- HAR-OP-Renal: Renal Hypertension-Clerical
- HAR-OP-Renal: Renal Transplant - Clerical
- HAR-OP-Rheumatology-Clerical
- HAR-OP-Surgery: Bariatric Surgery-Clerical
- HAR-OP-Surgery: Breast Surgery-Clerical
- HAR-OP-Surgery: Cardiothoracic Surgery-Clerical
- HAR-OP-Surgery: Colorectal Surgery-Clerical
- HAR-OP-Surgery: Dentistry-Clerical
- HAR-OP-Surgery: Neurosurgery-Clerical
- HAR-OP-Surgery: Ophthalmology-Clerical
- HAR-OP-Surgery: Oral and Maxillofacial Surgery-Clerical
- HAR-OP-Surgery: Orthopedic Surgery-Clerical
- HAR-OP-Surgery: Otolaryngology-Clerical
- HAR-OP-Surgery: Plastic Surgery-Clerical
- HAR-OP-Surgery: Surgical Oncology-Clerical
- HAR-OP-Surgery: Trauma Surgery-Clerical
- HAR-OP-Surgery: Urology-Clerical
- HAR-OP-Surgery: Vascular Surgery-Clerical
- HAR-OP-Pediatrics: Allergy/Asthma-Clerical
- HAR-OP-Pediatrics : Cardiology - Clerical
- HAR-OP-Pediatrics : Child Development - Clerical
- HAR-OP-Pediatrics : Craniofacial - Clerical
- HAR-OP-Pediatrics : Diabetes - Clerical
- HAR-OP-Pediatrics : Endocrinology - Clerical
- HAR-OP-Pediatrics : Failure to Thrive - Clerical
- HAR-OP-Pediatrics : Gastroenterology - Clerical
- HAR-OP-Pediatrics : Hematology - Clerical
- HAR-OP-Pediatrics : High Risk Infant - Clerical
- HAR-OP-Pediatrics : Immunology - Clerical
- HAR-OP-Pediatrics : Infectious Disease - Clerical
- HAR-OP-Pediatrics : Medical Genetics - Clerical
- HAR-OP-Pediatrics : Nephrology - Clerical
- HAR-OP-Pediatrics : Neurology - Clerical
- HAR-OP-Pediatrics : Nursery - Clerical
- HAR-OP-Pediatrics : Oncology - Clerical
- HAR-OP-Pediatrics : Rheumatology - Clerical
- HAR-OP-Pediatrics : Surgery - Clerical
Anticoagulation (Coumadin) Clinic
- ED Request for Specialty Appointment: ANTICOAGULATION (Return)
- Book without consultant approval
- Patient must be an established patient in the anticoagulation clinic seen in the last 12 months
- Request the specific date for 7 days post initiation of anticoagulation
- M-F 8am-4pm Ext. 5159, M-F after hours 4-9pm pager 9995, Sat-Sun 8am-8pm Pager 9995
Breast Diagnostic Center (Radiology)
- BDC is a Radiology Imaging Center for mammograms and ultrasounds. NOT the same as Breast Surgery Clinic
- Breast Abscess - needing ultrasound guided needle aspiration as per https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis
- Breast Mass - need imaging and biopsy of mass/malignancy as per https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Breast_mass.2Fmalignancy
Breast Surgery Clinic
- Please consult the appropriate surgical service on any patient presenting to the ED within the 30-day post-operative period, even if for something seemingly unrelated to the surgery.
- During the daytime (7a-7p), you should always directly call Breast/Surg Onc (x9397)
- After hours (7p – 7a), these teams are covered by trauma.
- If you inadvertently call trauma for these services during the daytime, they have been instructed to have you directly page the appropriate service.
- e-Consult via PCP
- If the patient needs urgent follow-up <2 weeks for DHS patient, consider consult to breast surgery resident (through Trauma surgery) from the ED
- Only for Breast Abscess in DHS patients s/p bedside I&D, recurrent breast abscess/mastitis, as per https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis
- Only for Breast Mass in DHS patient with imaging and tissue biopsy results already done https://www.wikem.org/wiki/Harbor:Operations_manual#Breast_mass.2Fmalignancy
- Otherwise, they need referral to the Breast Diagnostic Center (BDC) first for imaging
- Patients with metastatic disease - consult (Medical) Oncology from the ED
- If the patient was previously followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Breast Surgery-Clerical
BURN CENTER CLINIC
- For DHS eligible patients that need Burn Center follow up at LAC+USC, please call over 24/7 to their Burn Unit Front Desk 323-409-7991 to get an appointment w/in 2-5d depending on your assessment of their acuity.
- Inform the clerk there that you’d like to book a patient into the Burn Eval and Treatment area, which is in 5D in the Inpatient Tower (NOT their A5D Clinic).
- Patients can also call if they have questions about their appointment logistics or want to change their appointment time.
- If you are instructed to call the MAC to make an appointment (this is NOT a transfer), send Dr. Wu an email of the patient’s info, date/time, or use the QR code to submit an admin issue.
- For OOP patients, they can go to Torrance Memorial
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 Mariedel Morales and Sheila Walters IC, the Cardiology clerks, to book).
- For ZioPatch (holter monitor) - message empaneled PCP or CCC for cardiology
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Cardiology: Anticoagulation-Clerical
- HAR-OP-Cardiology: General Cardiology-Clerical
- HAR-OP-Cardiology: HFDMP-Clerical
Stress Testing
COLORECTAL Surgery (CRS)
- Please consult the appropriate surgical service on any patient presenting to the ED within the 30-day post-operative period, even if for something seemingly unrelated to the surgery.
- During the daytime (7a-7p), you should always directly call CRS (x0044)
- After hours (7p – 7a), these teams are covered by trauma.
- If you inadvertently call trauma for these services during the daytime, they have been instructed to have you directly page the appropriate service.
- Coming Soon: ED Request for Specialty Appointment order in Orchid
- ONLY if proven colorectal cancer; if unproven cancer, use CCC for EWC
- Book <2 weeks: HAR Colorectal Surgery New (ok to overbook)
- Any other colorectal (non-malignancy) issues, book <4 weeks
- ONLY if proven colorectal cancer; if unproven cancer, use CCC for EWC
DERM
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Dermatology-Clerical
ENT
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Otolaryngology-Clerical
Expedited Work-up Clinic (EWC)
GYN
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-OB/Gyn: Gyn Oncology-Clerical
- HAR-OP-OB/Gyn: Gyn Urgent Care-Clerical
- HAR-OP-OB/Gyn: Reproductive Endo/Infertility-Clerical
- HAR-OP-OB/Gyn: UroGyn-Clerical
- HAR-OP-OB/Gyn: Women's Health-Clerical
Gyn UCC
- Book without consultant approval
- 3-4d f/up for ALL DHS PID patients (cervical motion tenderness or adnexal tenderness, empirically treated)
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-OB/Gyn: Gyn Urgent Care-Clerical
Interventional Radiology
Limb Salvage
- Opting out of automatic 30-day automatic f/up consult
- Weekdays 7a - 5p
- If the patient seems stable for outpatient follow-up:
- Page limb salvage p0847
- After discussion with on-call resident/NP, initiate a TEAMS Chat with: ED attending, ED resident, LS on-call res/NP, LS on-call Attending and send a picture of the involved foot
- The limb salvage team may respond with appropriate outpatient f/up timeframe or may notify you they will come see the patient in the ED if they feel it is necessary
- If the patient seems stable for outpatient follow-up:
- Afterhours (5p - 7a weekdays, weekends, holidays)
- Consult trauma if the patient needs surgical evaluation; trauma will liaise with limb salvage attending
- Do NOT consult surgery for appointment
- For appointment only, can directly contact limb salvage OR defer to PCP for e-consult to podiatry (at MLK) if appropriate (several weeks to f/up)
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- Clerk books directly into HAR Surg VASC -> Podiatry New
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- Consult trauma if the patient needs surgical evaluation; trauma will liaise with limb salvage attending
A. Wu, MD - ED Director of Ops & A. Miller, DPM - Director of Limb Salvage, Co-Chair of DHS Podiatry Workgroup 3/30/22
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)
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Renal: General Nephrology-Clerical
- HAR-OP-Renal: Renal Hypertension-Clerical
- HAR-OP-Renal: Renal Transplant - Clerical
Neurosurgery
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Neurosurgery-Clerical
OB
- For new desired pregnancy w/out anticipated complications: discharge patient with OB clinic intake phone number (424-306-7200) so they can schedule appointment. OB intake is a medical assistant appt, NOT a provider
- For patients with needing serial beta HCGs, patient should follow with Gyn UCC w/in 2-4 days
- For patients considering pregnancy termination or interested in discussing options: discharge patient with general Gyn clinic phone number (424-306-4061), they can request appointment with ROC (reproductive options clinic)
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
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Ophthalmology-Clerical
- Ophtho Alphabet soup:
AAU: acute anterior uveitis AFT: artificial tears AGV: Ahmed glaucoma valve ARMD or AMD: age-related macular degeneration DR: diabetic retinopathy BRAO: branch retinal artery occlusion BRVO: branch retinal vein occlusion BULB: bilateral upper lid blepharoplasty BVS: borderline visually significant C/D: cup-to-disc ratio CEIOL: cataract extraction with insertion of intraocular lens CME: cystoid macular edema CRAO: central retinal artery occlusion CRVO: central retinal vein occlusion CSME: clinically significant macular edema CS: cortical spoking (cataract) CSR: central serous retinopathy DES: dry eye syndrome DME: diabetic macular edema DWC: dense white cataract ED: epithelial defect EL: endolaser ERM: epiretinal membrane FML: focal macular laser GS: glaucoma suspect HST: horseshoe tear HVF: Humphrey visual field K: cornea LH/WC/AFTs: lid hygiene, warm compresses, artificial tears LPI: laser peripheral iridotomy MMCR: Muller's muscle conjunctival resection MP: membrane peel NCVH: non-clearing vitreous hemorrhage NPDR: non-proliferative diabetic retinopathy NS: nuclear sclerosis (cataract) NTG: normal tension glaucoma NVG: neovascular glaucoma NVS: not visually significant OD: right eye OHTN: ocular hypertension OS: left eye OU: both eyes POAG: primary open angle glaucoma PCO: posterior capsular opacity (aka, secondary cataract) PDR: proliferative diabetic retinopathy PKP: penetrating keratoplasty (aka corneal transplant) PPV: pars plana vitrectomy PRP: pan retinal photocoagulation PSC: posterior subcapsular cataract PTG: pterygium PVD: posterior vitreous detachment RRD: rhegmatogenous retinal detachment RT: retinal tear SB: scleral buckle SRD: serous retinal detachment Trab: trabeculectomy TRD: tractional retinal detachment VA: visual acuity VH: vitreous hemorrhage VS: visually significant XT: exotropia YAG cap: YAG capsulotomy
ORTHO
- Starts 5/1/23
- Make sure you're signed off on splinting Splinting Guide with Videos
- File:Ortho consult criteria_Harbor_Final.pdf
- Book: depends on injury, see below, with or without consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Orthopedic Surgery-Clerical
- Diagnoses Where Orthopedics SHOULD Be Consulted While Patient is in the ED
- Consult after XR or other appropriate workup is complete. A single scout film may be the appropriate initial imaging for polytrauma patients with obvious open fracture.
- Incarcerated or non-DHS patients with a diagnosis not found on the “refer to primary care list” may benefit from an orthopedic consult (call orthopedics to review if unsure) to optimize their pre-discharge care and specify timeframe for f/up
- Always ask/consult if unsure!
- General:
- Acute hardware infection
- Amputation (including subtotal amputation with dysvascular distal part)
- Chronic osteomyelitis (not related to diabetic foot infection [admission guideline])
- Compartment syndrome in extremity with fracture
- Crush injury to the extremity (other than distal tuft)
- Irreducible fracture or dislocation
- Laceration or fracture with tendinous or neurovascular injury or symptoms
- Open fracture of an extremity or impending open fracture (eg, a fracture resulting in skin tenting)
- Open joint, acute foreign body in joint (consult ortho prior to challenge when high suspicion)
- Septic joint (ED to perform arthrocentesis outside region of erythema/cellulitis and consult if results are concerning for infection or if unable to aspirate)
- Any pediatric fractures requiring procedural sedation or surgery
- Clavicle
- Clavicle fracture with >5mm displacement
- AC joint dislocations, types 4-6
- Arm/forearm
- Proximal humerus fracture with displacement
- Humeral shaft fracture with displacement
- Any displaced elbow fracture (radial head/neck, distal humerus, olecranon, coronoid)
- Radius, Ulna, or both bone forearm fracture
- Distal radius fracture with displacement
- Wrist/Hand
- Scaphoid fracture with displacement
- Acute lunate or perilunate dislocation
- Flexor tenosynovitis
- Flexor tendon (palmar hand) injuries
- Metacarpal fractures with angulation or malrotation or involving multiple MCs
- Any clenched fist injury, (aka: fight bite)
- Pressure injection injuries
- Hand/finger abscesses (excluding paronychia and felon)
- Reduced DIP/PIP/MCP/CMC dislocations
- Displaced Phalangeal fractures (other than distal tuft)
- Nailbed injury with underlying distal phalanx fracture aka Seymour fracture (excluding tuft)
- Pelvis/thigh/knee
- Any pelvic fracture
- All hip and knee dislocations
- Any femur fracture
- Patella fractures
- Acute patellar or quadriceps tendon rupture
- Multi-ligamentous knee injury (i.e. dislocated knee s/p spontaneous relocation)
- Leg/ankle
- Any tibial plateau fracture (please discuss case with ortho prior to ordering any CT)
- Any tibial shaft fracture
- Pilon (distal tibia articular impaction) fractures
- Ankle fractures with displacement (call orthopedics to review XR if unsure)
- Foot
- Calcaneus fractures
- Talus fractures
- Subtalar dislocations
- Lisfranc injuries (including 1st and 2nd metatarsal base fractures)
- Navicular / Cuboid / Cuneiform fractures
- General:
- Diagnoses which can be stabilized by ED and REFERRED TO ORTHO Fracture Clinic in 2 weeks unless otherwise specified
- Establishing follow up after outside hospital orthopedic procedure
- Any fracture with radiographic healing (eg, callus formation)
- Chronic foreign body in joint
- Fractured non-unions or malunions
- Symptomatic orthopedic hardware
- Shoulder/arm
- Isolated scapular body fracture
- Non-displaced/minimally displaced (<5mm midshaft clavicle fracture)
- AC joint dislocation, types 1-3 (DESCRIBE TYPES 1,2,3)
- Rotator cuff tear confirmed on MRI (Ortho Sports Clinic, NOT fracture clinic)
- Nondisplaced proximal humerus fracture (DEGREE OF ANGULATION - sling vs sarmiento?)
- Elbow/forearm
- Elbow and shoulder dislocations with no associated fracture that have appropriate imaging confirming reduction** (perfect lateral for the elbow, axillary, Velpeau, or CT for the shoulder). call orthopedics to review XR if unsure
- Nondisplaced Radial head/neck fracture (splint then Ortho Fracture Clinic - WHY IS THIS LISTED - WHOLE SECTION TO FX CLINIC)
- Nondisplaced distal radius fracture (splint then Ortho Hand Clinic, NOT Fracture Clinic)
- Wrist/Hand
- Occult scaphoid fracture (Ortho Hand clinic, NOT Ortho Fracture Clinic)
- Non-displaced phalangeal and metacarpal fracture (intrinsic plus splint then refer to clinic; boxer's fractures ok to put into soft dressing then refer to hand clinic - BUDDY TAPE?)
- Extensor tendon (dorsal hand) injuries (splint then refer to Ortho Hand Clinic in <7 days, NOT Ortho Fracture Clinic)
- Distal phalanx fracture without nailbed injury (excluding tuft - Ortho Hand clinic, NOT Ortho Fracture Clinic)
- Distal phalanx fracture with subungual hematoma (Ortho Hand Clinic, NOT Ortho Fracture Clinic)
- Nailbed injury WITH tuft fracture or without underlying distal phalanx fracture, after ED repair (Ortho Hand Clinic, NOT Ortho Fracture Clinic) ABX IF OPEN?
- Lower extremity
- Patellar dislocation s/p relocation (if DHS Empaneled --> Ortho Sports Clinic)
- Single knee ligament injuries (eg, isolated ACL rupture, meniscal injuries confirmed on outpt MRI - ED MRI not indicated; if DHS Empaneled --> Ortho Sports Clinic)
- Ankle fractures without displacement subluxation or dislocation (call orthopedics to review XR if unsure)
- Achilles tendon rupture
- Fracture of 1st-5th metatarsal shafts
- Diagnoses which can be stabilized by ED and REFERRED TO ORTHO Fracture Clinic in 2 weeks unless otherwise specified
- Diagnoses which can be stabilized by ED and referred to Primary Care (NO ORTHO CONSULT NEEDED)
- Arthritis (osteoarthritis of knee or hip OR inflammatory arthritis [consider rheumatology referral])
- Cellulitis
- Chronic pain
- Toes:
- Closed minimally displaced distal phalanx fracture can be treated with buddy tape & hard sole shoe
- Closed fractures of the lesser (2nd-5th) toe phalanges
- Deep foreign body in extremity without neurovascular symptoms, fracture, or joint involvement
- Gunshot wound to extremity without fracture, tendinous, or neurovascular injury (DHS-empaneled patients may be referred to Ortho Joint Reconstruction Clinic)
- Shoulder impingement
- Sprains, strains, or contusions (no fracture or joint space widening on radiographs)
- Tendonitis
- Diagnoses which can be stabilized by ED and referred to Primary Care (NO ORTHO CONSULT NEEDED)
PEDIATRIC ORTHO
- Orthopedic conditions that can be managed in the ED with Orthopedic follow-up (must be neurovascular intact; ED clerk can book into orthopedic fracture clinic):
- Radius, ulna, fibula, clavicle, tibia fractures
- < 5mm displaced and < 15 degrees angulation
- Pain controlled by oral meds
- Normal neurovascular status
- 5 years and older
- Proximal humerus fractures with minimal displacement – place in sling
- Elbow trauma with elevated posterior fat pad, no visible fracture
- Foreign bodies not in bone or joint space
- Salter Harris 1 fractures that are not displaced
- Distal phalanx fractures not involving joint space
- Tuft fractures
- Radius, ulna, fibula, clavicle, tibia fractures
- Peds Specifics
- OK to Splint; DHS Eligible
- Call ortho and ask for approval to book in clinic the next Tuesday for Pediatric fracture clinic.
- Ortho does not have to see the patient or write a consultation
- OK to splint; OOP (these will not qualify for CCS)
- D/c patient with copies of films
- Specific instructions to family to call and get ortho referral
- Hand-out available with options for families (PMD, Shriner’s, Orthopedic institute)
- Patients Seen at OH splinted and referred to Harbor; Call ortho if:
- DHS eligible or empaneled
- Believe urgent/emergent intervention needed
- Needs a reduction
- Patient having difficulty getting into empaneled orthopedist (can give hand-out of other options).
- Ortho attempts to get CCS and if not able helps get care
- Ortho and CCS (California Children’s Services)
- Ortho has hired Anna Contreras ( Daisy) to help get CCS for many of the OOP ortho patients
- If patient is OOP and ortho requests to see them after they splint or cast send a communication to Anna Contreras through Cerner and she gets back to families within 1 business day.
- Instructions on each computer in PED doc box
- If the patient doesn’t qualify for CCS, they will help the family get into their orthopedist
- Ortho and CCS (California Children’s Services)
- Ortho attempts to get CCS and if not able helps get care
- OK to Splint; DHS Eligible
PEDIATRICS
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Pediatrics: Allergy/Asthma-Clerical
- HAR-OP-Pediatrics : Cardiology - Clerical
- HAR-OP-Pediatrics : Child Development - Clerical
- HAR-OP-Pediatrics : Craniofacial - Clerical
- HAR-OP-Pediatrics : Diabetes - Clerical
- HAR-OP-Pediatrics : Endocrinology - Clerical
- HAR-OP-Pediatrics : Failure to Thrive - Clerical
- HAR-OP-Pediatrics : Gastroenterology - Clerical
- HAR-OP-Pediatrics : Hematology - Clerical
- HAR-OP-Pediatrics : High Risk Infant - Clerical
- HAR-OP-Pediatrics : Immunology - Clerical
- HAR-OP-Pediatrics : Infectious Disease - Clerical
- HAR-OP-Pediatrics : Medical Genetics - Clerical
- HAR-OP-Pediatrics : Nephrology - Clerical
- HAR-OP-Pediatrics : Neurology - Clerical
- HAR-OP-Pediatrics : Nursery - Clerical
- HAR-OP-Pediatrics : Oncology - Clerical
- HAR-OP-Pediatrics : Rheumatology - Clerical
- HAR-OP-Pediatrics : Surgery - Clerical
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
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Pediatrics : Cardiology - Clerical
PLASTIC SURGERY
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Plastic Surgery-Clerical
PULMONARY
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
PROCEDURE CLINIC
- For patient needing recurrent paracentesis
- From Dr. Anshu Abhat:
- only available for patients who are empaneled to Harbor-UCLA Internal Medicine or Geriatrics clinic.
- If an ED provider thinks a patient could benefit from procedure clinic, they should include this in the ER note/documentation (ideal) or message the empaneled provider. Referrals to procedure clinic should only come from PCP's (not from ER providers).
RHEUM
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Rheumatology-Clerical
STI Testing
- HAR Positive Care Clinic
- DHS empaneled patients only 18 y/o and above with high-risk behavior (multiple partners, recurrent STI, etc)
- M-F 8a-4:40p
- x64350 to schedule appt
- can Orchid message Claudia Murray, RN and Vanessa Salguero (clerk) after hours; include reason for referral (eg: “referral for HIV/STI testing in a patient with multiple partners”)
- Offers:
- HIV/STI testing
- HIV Pre Exposure Prophylaxis (PrEP)
SURGERY
- Please consult the appropriate surgical service on any patient presenting to the ED within the 30-day post-operative period, even if for something seemingly unrelated to the surgery.
- During the daytime (7a-7p), you should always directly call CRS (x0044), Bariatric/MIS (x0802), Pediatric (x6105), Breast/Surg Onc (x9397), and Vascular (x0503 – note the new pager number).
- After hours (7p – 7a), these teams are covered by trauma.
- If you inadvertently call trauma for these services during the daytime, they have been instructed to have you directly page the appropriate service.
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Bariatric Surgery-Clerical
- HAR-OP-Surgery: Cardiothoracic Surgery-Clerical
- HAR-OP-Surgery: Colorectal Surgery-Clerical
- HAR-OP-Surgery: Plastic Surgery-Clerical
- HAR-OP-Surgery: Surgical Oncology-Clerical
- HAR-OP-Surgery: Trauma Surgery-Clerical
- HAR-OP-Surgery: Vascular Surgery-Clerical
UROLOGY
- Nephrolithiasis
- OK for clerk to book per Dr. Blumberg within 7-10d without calling urology consultant if meet below criteria
- New Dx Nephrolithiasis
- BMP, UA, consider CT for size/location/hydro (US if pregnant), have patients strain urine
- Established Nephrolithiasis
- BMP, UA, bedside US for hydro
- New Dx Nephrolithiasis
- OK for clerk to book per Dr. Blumberg within 7-10d without calling urology consultant if meet below criteria
- CALL urology consult for patients with UTI (infected stone), h/o DM, solitary kidney, pregnancy
- PCP follow-up if not already established, then can NERF when appropriate.
- PCP for non-obstructive <5mm stones
- Ureteral stent or percutaneous nephrostomy tube pain without concern for infection, otherwise uncomplicated course, follow-up in urology clinic in 7 days
- Send Urine culture
- Acute urinary retention
- OK to book in Urology Clinic in 10-14 days WITHOUT consult approval per Dr. Blumberg if near baseline Cr, no significant electrolyte derangements, no evidence of post-obstructive diuresis, pain is controlled, and tolerating PO's
- Place foley, send UA, BMP; do NOT sent PSA (falsely elevated with acute retention)
- If <200ml output, remove catheter
- If >400ml out, maintain catheter
- Monitor for post obstructive diuresis. If >200ml/hr for 2 hours (not counting the initial output), consider further observation and IVF resusc
- Discharge with tamsulosin 0.4 mg daily
- All other Urologic conditions: book with consultant approval - write name of approving doctor, time frame, and reason for follow up
- Epididymitis/orchitis just needs PCP f/up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Urology-Clerical
Per Dr. Blumberg (Urology) & Dr. Wu 2/8/22
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