Harbor:ED follow-up options

Patients who CANNOT follow up at Harbor

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

Patients who CAN follow up at Harbor

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, sz disorder. No more CHC list. This is better for our patients as they’ll get more intensive customer service to help them find a clinic. However, patients without chronic conditions will not get PMDs (probably not really a change from previous reality). If your patient is homeless, can consider scheduling into Lomita FM so patient can leave with appointment in hand.
  • DHS empaneled patients requiring 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 empaneled/LA County uninsured: call specialty service for approval and have clerk book in Orchid
  • Limited Lomita/Family med and expedited workup clinic spots
  • Out of county uninsured: have the patient call 2-1-1 from anywhere in California for a call center/clearinghouse for health services.
  • Insured patients: Refer to their own health plan

Specialty Clinics We Can Book Into After Consultation

  • Trauma
  • Ortho
  • Derm
  • Ophtho (same day appointments)
    • Discharge the patient from the ED to ophtho clinic, unless you feel they have ongoing medical issues that require them coming back to ED
    • If they require admission, can be admitted from there or sent back to ED
  • GYN UC (often all booked so have to call)
  • Cardiology
  • Family Medicine Sports Clinic (Fridays)—only SPORTS related injuries

NEVER REFER TO PAIN CLINIC!

Scheduling Outpt Studies

  • Stress Testing
    • Form in Affinity
      • Fill out and print to heart station
      • Patient Charting
      • Click Chart Assessment Tab
      • Click RECORD
      • Click on Exercise Treadmill
      • Complete form entirely
      • SAVE AS FINAL
      • Print to HEART
      • Clerk makes appointment and PUTS order in computer
      • Can only schedule treadmills on an urgent basis (<72 hrs); if you want a MIBI or stress ECHO can use same process but it will be a mail-out
  • US or MRI
    • In general: DON’T DO IT!
    • Never do it for DVT: US bounces all of these back
    • In select cases in which a specific follow-up clinic requests a test, you can order it via Affitnity, similar to above, with the following caveat:
      • DO NOT PUT YOUR NAME OR ER AS THE ORDERING PHYSICIAN OR DEPARTMENT. PERIOD
  • Outpt Labs
    • Okay in certain circumstances
    • ONLY if patient will have a follow-up appointment in one of our clinics within 1-2 days of the lab draw!
    • How to do it?
      • Get lab draw slip from clerk
      • Clerk can order the outpatient labs that you want
      • Recommend you don’t do this unless you talked to somebody who is willing to have their name go on the lab slip and follow-up the results

See Also

Harbor: Harbor (Main)