Difference between revisions of "Harbor:Main"

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''This is the main page for Harbor-UCLA emergency department; See [[Harbor:Pediatric ED (main)|Pediatric ED]] for the main Harbor pediatric page.''
 
''This is the main page for Harbor-UCLA emergency department; See [[Harbor:Pediatric ED (main)|Pediatric ED]] for the main Harbor pediatric page.''
==Message of the Moment==
+
==Admin Updates==
Check here for the latest in ED administrative news!
+
*EWC - 8/5/19 - back to scheduling directly into EWC; Cerner is working again!
 +
*Surge Criteria Pilot - 7/10/19:  ED census for surge criteria includes R5, R6, R7, & R12;  Available med/surg '''OR''' ICU/PCU
 +
(Dr. Peterson, Dr. Stein, Mark Redulla [pt flow])
 +
*PERT (PE Response Team) Started Monday 6/24
 +
** Page the PERT Fellow p9956 for (sub)massive PE when considering thrombolytics
 +
** for details:  https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Pulmonary_Embolus
  
==[[Harbor: Administrative Resident Role|General Administrative]]==
+
==General Administrative==
*[[Harbor:Administrative resident|Administrative resident directions]]
+
*Pre-hospital
*[[Harbor: Phone Calls|Receiving Phone Calls]]
+
**[[Harbor:Incoming transfers|Incoming transfers]]
**[[Harbor:Critical Result Callback]]
+
===[[Harbor:Screening EMS Patients|Screening EMS Patients]]===
*[[Harbor: Triaging Ambulance Runs|Triaging Ambulance Runs]]
+
===Administrative duties===
*[[Harbor:EKG screening|EKG Screening]]
+
**[[Harbor:Administrative resident|Administrative resident directions]]
*[[Harbor:5S|Pre-shift: 5S]]
+
**[[Harbor: Phone Calls|Receiving Phone Calls]]
*[[Harbor:Legal]]
+
***[[Harbor:Critical Result Callback|Critical Result Callback]]
 +
**[[Harbor:EKG screening|EKG Screening]]
 +
**[[Harbor:5S|Pre-shift: 5S]]
 +
**Airway Bag
 +
***Missing or low on equipment such as McGrath blades or batteries - inform the overall charge nurse (more in nursing office)
 +
***PURPLE SENIOR - use the laminated checklist to stock AT EACH SHIFT CHANGE on on-call days
 +
***Locks let you know which compartments to check
 +
***ED pharmacists help with meds BUT SENIORS should double check.
 +
***TURN OFF McGRATH AFTER USE!
 +
*** Can use new “GlideScope Go” with a MAC 3 & 4 blade, but bring it back. (It’s not  part of bag).
 +
Wu 11/2019)
 +
===Administrative resources===
 +
**[[Harbor:RME & TRIAGE|RME & triage]]
 +
**[[Harbor:Direct Admission after Hours]]
 +
**[[Harbor:Core Measures|Core Measures]]
 +
**[[Harbor:ED policy manual|Harbor ED policy manual]]
 +
**[[Harbor:ED attending on call plan|ED attending on call plan]]
 +
**[[Harbor:Legal|Harbor Legal]]
  
 
==Managing your Patient==
 
==Managing your Patient==
===Ordering===
+
===General===
*[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
+
====[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]====
*[[Harbor:Ultrasound Approval List|Ultrasound approval list]]
+
====[[Harbor:Paging|Paging consultants]]====
*[[Harbor:Ordering a CT|Ordering a CT]]
+
====[[Harbor:Phone numbers|Phone numbers]]====
*[[Harbor:Ordering Blood Products|Ordering Blood Products]]
+
 
*Ordering antibiotics
 
**[[Harbor:Antibiogram|Harbor antibiogram]]
 
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
 
***[[Harbor:Sepsis core measures|Sepsis core measures]]
 
  
===Documenting===
+
===Tests & Orders===
*[[Harbor:Attending documentation|Attending documentation]]
+
*[[Harbor:Labs|Labs]]
*[[Harbor: Consenting a Patient|Consenting a Patient]]
+
*Radiology
*[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]
+
====[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]====
*[[Harbor: Macros and Autotext]]
+
*Ultrasound
 +
**[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
 +
**[[Harbor:Ultrasound Approval List|Ultrasound approval list]]
 +
**[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
 +
**Cleaning Endocavitary Probes
 +
***Place in Red Bag (above probe cabinet in clean utility room)
 +
***Place patient sticker on bag
 +
***Give to area charge nurse
 +
***Once cleaned, probe comes back in clear bag
 +
***T. Jang 8/2019
  
===Procedures===
+
*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
*[[Harbor:Equipment|Equipment]]
+
*CT
*[[Harbor:Consenting a patient|Consenting a patient]]
+
**[[Harbor:Ordering a CT|Ordering a CT]]
 +
**[[Harbor:ED Radiology Specs|CT Specs]]
  
===Finding Things===
+
====[[Harbor:STAT MRI|STAT MRI]]====
*[[Harbor:Forms|Forms]]
+
*[[Harbor:ED Radiology Specs|MRI Specs]]
*[[Harbor:Paging|Paging consults]]
+
*Other orders
 +
**[[Harbor:Ordering Blood Products|Blood products]]
 +
**Antibiotics
  
===Special patient types===
+
====[[Harbor:Antibiogram|Antibiogram]]====
*[[Harbor:Occupational exposure|Occupational exposure]]
 
*Sepsis
 
 
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
 
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
**[[Harbor:Sepsis core measures|Sepsis core measures]]
+
***[[Harbor:Sepsis core measures|Sepsis core measures]]
*[[Harbor:Code stroke|Acute stroke]]
+
*Buprenorphine/Opiate Withdrawal Treatment
*[[Harbor:AVF/graft complications|AVF/graft complications]]
+
**[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
*[[Harbor:Respiratory isolation|Respiratory isolation]]
 
  
==Patient Disposition==
+
==== Upload Outside Films to PACS====
===[[Harbor:Discharge|Discharging a Patient]]===
+
*Get form from clerk
*[https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]
+
*Put patient sticker on Form
*[[Harbor: ED Follow-Up Options|ED Follow-Up]]
+
*Check "Import"
*[[Harbor:Coumadin clinic|Coumadin clinic]]
+
*Sign
*[[Harbor:Expedited workup clinic|Expedited workup clinic]]
 
*[[Harbor:Prescribing|Prescribing]]
 
  
===[[Harbor:Admitting a patient|Admitting a patient]]===
+
==== Get Images on Disc (For DC or Transfer)====
*[[Harbor:Admission and consultation guidelines|Who goes to what service (Admission and consultation guidelines)]]
+
*Same as upload EXCEPT
**[[Harbor:Internal Medicine Admissions|Internal Medicine Admissions]]
+
**Check "Export"
**[[Harbor:C-Team|C-Team Admissions]]
+
**Write time frame on form you want studies from
**[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
 
*[[Harbor:Paging|Paging consultants]]
 
  
===Other===
+
===Finding Equipment/DME===
*[[Harbor:Deceased patients|Deceased patients]]
+
*[[Harbor:Equipment|Equipment (AED/RME)]]
*[[Harbor:Administrative resident|Transfers]]
+
*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
 +
*[[Harbor:DME|Durable Medical Equipment (DME)]]
  
==[[Harbor:Disaster info|Disaster]]==
+
====ED supplies A-Z====
*[[Harbor:Disaster info|General disaster info]]
+
*A-Z listing for entire ED
*[[Harbor:Surge plan]]
+
** Glidescopes - trauma 1-7
*[[Harbor:Ebola|Suspected Ebola protocol]]
+
** Slit Lamps - AED 1, teaching lamp in RME 10
 +
*Main Supply Room A-Z
 +
**[[File:WikEM1.jpg|400px]]
 +
**[[File:WikEM2.jpg|400px]]
 +
**[[File:WikEM3.jpg|400px]]
 +
**[[File:WikEM4.jpg|400px]]
 +
*Main Supply Room by cart
  
==See Also==
+
*Airway Cart
*[[Harbor:Operations manual]]
+
*Central Line Cart
*[[Harbor:VA MICU rotation]]
+
*Ortho/splinting Cart
*[[Harbor:Teaching Rounds Topics]]
+
*Precipitous Delivery (BOA) Cart
*[[Harbor:How to get started in research at Harbor]]
+
*RME 1-4 Carts
*[[Harbor:RME Manual]]
+
*Suture Cart
*[[Harbor:Code STEMI]]
+
*Triage Hall Cart
 +
*Triage Room Carts
  
 +
===Procedures===
 +
*[[Harbor:Consenting a patient|Consenting a patient]]
 +
*[[Harbor:Procedures Videos|Procedure Videos]]
  
[[Category:Admin]]
+
==Special patient types==
 +
*[[Harbor:Whole person care|Whole person care]]
 +
*[[Harbor:Social work|Social work]]
 +
*Activations
 +
**[[Harbor:Codes|Code Activations]]
 +
***[[Harbor:Involuntary holds|Involuntary holds]]
 +
**[[Harbor:Airway management team|Airway management team]]
 +
**[[Harbor:Code stroke|Code Stroke]]
 +
**[[Harbor:Code STEMI|STEMI Activation]]
 +
**[[Harbor:Trauma activations|Trauma Activations]]
 +
*Sepsis
 +
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
 +
**[[Harbor:Sepsis core measures|Sepsis core measures]]
 +
*'''[[Harbor:Occupational exposure|Occupational Exposure]]'''
 +
*[[Harbor:Industrial Accident (IA)|Industrial or On-the-Job Accidents (IA)]]
 +
*'''[[Harbor:Non-Occupational Exposure|Sexual Assault/STI Exposure (SART)]]'''
 +
*[[Harbor:PE Response Team]]
  
==Pre-hospital/Surge Plans==
+
===Others===
===[[Harbor:Incoming transfers|Incoming transfers]]===
+
*[[Harbor:AVF/graft complications|AVF/graft complications]]
===Ambulance Triage===
+
*[[Harbor:Respiratory isolation|Respiratory isolation]]
*[[Harbor:Screening EMS Patients|Screening EMS Patients]]
+
*[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]
===Surge Criteria and Plan===
 
*[[Harbor:Surge Plan/Disasters|Harbor Surge Plan/Disasters]]
 
*[[Harbor:Disaster plan|Harbor disaster plan]]
 
 
 
===Orchid Downtime===
 
*[[Harbor:ORCHID Downtime|ORCHID Downtime]]
 
===ID:  Flu, Hepatitis, Ebola===
 
 
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
 
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
 
+
**[[Harbor:Ebola|Suspected Ebola protocol]]
==[[Harbor:Labs|Labs]]==
+
*[[Harbor:Replantation Patients|Replantation Patients]]
 
+
*[[Harbor:XRT|XRT transfers]]
==Radiology==
 
*[[Harbor:ED Radiology Specs|MRI Specs]]
 
*[[Harbor:ED Radiology Specs|CT Specs]]
 
*[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
 
*[[Harbor:STAT MRI|STAT MRI]]
 
*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
 
 
 
==EQUIPMENT==
 
*[[Harbor:Equipment|Equipment (AED/RME)]]
 
*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
 
===Ordering DME===
 
*[[Harbor:DME|Durable Medical Equipment (DME)]]
 
 
 
==IA/Exposures==
 
===[[Harbor:Occupational exposure|Occupational Exposure]]===
 
*[[Harbor:Industrial Accident (IA)|Industrial or On-the-Job Accidents (IA)]]
 
===Sexual Assult/STI Exposure===
 
*[[Harbor:Non-Occupational Exposure|Sexual Assult/STI Exposure]]
 
  
 
==Patient Disposition==
 
==Patient Disposition==
===F/up Flowchart===
+
===Discharge===
* https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]
+
*[[Harbor:Prescribing|Prescribing]]
===[[Harbor: ED Follow-Up Options|ED Follow-Up Clinics]]===
+
*[[Harbor: ED Follow-Up Options|ED Follow-Up]]
 +
**[https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]
 +
*'''[[Harbor: ED Follow-Up Options|ED Follow-Up Clinics]]'''
 +
*'''[[Harbor:Forms|Forms]]'''
  
===[[Harbor:Discharge|Law Enforcement Escort]]===
+
*Follow-up of out patient labs/imaging
*[[Harbor:Prescribing|Prescribing]]
+
**Any imaging or 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.
 +
(Peterson 11/19)
  
===Other===
+
*[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
*[[Harbor:Deceased patients|Deceased patients]]
+
*[[Harbor:Substance Use Disorder|Substance Use Disorder]]
*[[Harbor:Transferring a patient|Transferring a patient]]
+
*[[Harbor:Medical Legal Partnership|Medical Legal Partnership]]
**[[Harbor:Transferring to psych ER|Transferring to psych ER]]
+
*[[Harbor:Immigration Legal Assistance|Immigration Assistance]]
 +
*[[Harbor:Hospital Based Violence Intervention Program and Trauma Recovery Center|Hospital Based Violence Intervention Program and Trauma Recovery Center]]
 +
*[[Harbor:Coumadin clinic|Coumadin clinic]]
 +
*[[Harbor:Expedited workup clinic|Expedited workup clinic]]
 +
*[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]]
  
==ADMISSIONS==
+
===Admission===
===Admission Policy===
+
*'''[[Harbor:Admission and consultation guidelines|Admission and consultation guidelines]]'''
 
*[[Harbor:Admitting a patient|Admitting a patient]]
 
*[[Harbor:Admitting a patient|Admitting a patient]]
 +
*[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
 +
*[[Harbor:Right level of care|Right level of care]]
 +
*[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
 +
*[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]]
 +
*[[Harbor:Direct Admission after Hours|Direct Admission after Hours]]
  
=== OBS & CORE===
+
===OBS & CORE===
 
*[[Harbor:Observation placement|Observation placement]]
 
*[[Harbor:Observation placement|Observation placement]]
 
*[[Harbor:CORE|CORE placement]]
 
*[[Harbor:CORE|CORE placement]]
 +
*Observation Patients Direct from UCC
 +
**Do not need an ED MSE - can go direct to OBS
 +
**If no OBS beds available in GOLD - should be made Direct Admits to the Hospital
 +
Peterson 8/2019
  
===Admission Guidelines===
+
===Other Disposition===
*[[Harbor:Admission and consultation guidelines|Admission and consultation guidelines (policy 312)]]
+
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
**[[Harbor:Right level of care|Right level of care]]
+
* [[Harbor:Deceased patients|Deceased patients]]
**[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
+
*[[Harbor:Transferring a patient|Transferring a patient]]
**[[Harbor:C-Team|C-Team Admissions]]
+
**[[Harbor:Transferring to psych ER|Transferring to psych ER]]
**[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
+
**[[Harbor:XRT|XRT transfers]]
*[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]]
+
**[[Harbor:Replantation Patients|Replantation patient transfer]]
 
 
===[[Harbor:Direct Admission after Hours|Direct Admission after Hours]]===
 
 
 
===Insurance Problems===
 
# For issues with insurance, refer patients to the CA Dept of Managed Healthcare:  https://www.dmhc.ca.gov/
 
 
 
==Physicians==
 
===[[Harbor:Forms|Forms]]===
 
 
 
===[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]===
 
 
 
===[[Harbor:Phone numbers|Phone numbers]]===
 
===[[Harbor:Paging]]===
 
 
 
===[[Harbor:ED attending on call plan|ED attending on call plan]]===
 
 
 
===[[Harbor:Trauma activations|Trauma Activations]]===
 
 
 
===[[Harbor:Code STEMI|STEMI Activation]]===
 
*[[Harbor:EKG STEMI Screening|ECG STEMI screening]]
 
 
 
===[[Harbor:Code stroke|Code Stroke]]===
 
 
 
===[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]===
 
  
 
==Documentation==
 
==Documentation==
===[[Harbor:Attending documentation|Attending Documentation]]===
+
*[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]
 +
**[[Harbor: Macros and Autotext|Macros and Autotext]]
 +
*[[Harbor:Attending documentation|Attending Documentation]]
 +
*[[Harbor:Resident documentation|Resident documentation]]
 +
*[[Harbor:Consenting a patient|Consenting a Patient]]
 +
**[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]
  
===[[Harbor:Resident documentation|Resident documentation]]===
+
==Disaster & Surge==
 +
*[[Harbor:Disaster plan|Disaster plan]]
 +
*'''[[Harbor:Surge plan|Surge plan]]'''
 +
*[[Harbor:ORCHID Downtime|ORCHID Downtime]]
 +
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
 +
**[[Harbor:Ebola|Suspected Ebola protocol]]
  
 +
==Resident Education==
 +
*[[Harbor:Teaching Rounds Topics|Teaching Rounds Topics]]
 +
*[[Harbor:VA MICU rotation|VA MICU rotation]]
 +
*[[Harbor:How to get started in research at Harbor|How to get started in research at Harbor]]
 +
*[[Harbor:Jeopardy Policy|Jeopardy Policy]]
  
===[[Harbor:Prescribing|Prescribing]]===
+
==See Also==
 +
*[[Harbor:RME Manual]]
  
===[[Harbor:Codes|Codes]]===
+
[[Category:Admin]]
 
 
===[[Harbor:Airway management team|Airway management team]]===
 
 
 
===[[Harbor: Macros and Autotext|Macros and Autotext]]===
 
 
 
==[[Harbor:RME & TRIAGE|RME & TRIAGE]]==
 
 
 
==[[Harbor:Social work|Social work]]==
 
 
 
===[[Harbor:Whole person care|Whole person care]]===
 
 
 
==[[Harbor:Core Measures|Core Measures]]==
 
 
 
==[[Harbor:ED policy manual|Harbor ED policy manual]]==
 

Revision as of 17:25, 20 November 2019

This is the main page for Harbor-UCLA emergency department; See Pediatric ED for the main Harbor pediatric page.

Admin Updates

  • EWC - 8/5/19 - back to scheduling directly into EWC; Cerner is working again!
  • Surge Criteria Pilot - 7/10/19: ED census for surge criteria includes R5, R6, R7, & R12; Available med/surg OR ICU/PCU

(Dr. Peterson, Dr. Stein, Mark Redulla [pt flow])

General Administrative

Screening EMS Patients

Administrative duties

    • Administrative resident directions
    • Receiving Phone Calls
    • EKG Screening
    • Pre-shift: 5S
    • Airway Bag
      • Missing or low on equipment such as McGrath blades or batteries - inform the overall charge nurse (more in nursing office)
      • PURPLE SENIOR - use the laminated checklist to stock AT EACH SHIFT CHANGE on on-call days
      • Locks let you know which compartments to check
      • ED pharmacists help with meds BUT SENIORS should double check.
      • TURN OFF McGRATH AFTER USE!
      • Can use new “GlideScope Go” with a MAC 3 & 4 blade, but bring it back. (It’s not part of bag).

Wu 11/2019)

Administrative resources

Managing your Patient

General

PC Cheat Sheet

Paging consultants

Phone numbers

Tests & Orders

Enter Prelim Rads Read

STAT MRI

Antibiogram

Upload Outside Films to PACS

  • Get form from clerk
  • Put patient sticker on Form
  • Check "Import"
  • Sign

Get Images on Disc (For DC or Transfer)

  • Same as upload EXCEPT
    • Check "Export"
    • Write time frame on form you want studies from

Finding Equipment/DME

ED supplies A-Z

  • A-Z listing for entire ED
    • Glidescopes - trauma 1-7
    • Slit Lamps - AED 1, teaching lamp in RME 10
  • Main Supply Room A-Z
    • WikEM1.jpg
    • WikEM2.jpg
    • WikEM3.jpg
    • WikEM4.jpg
  • Main Supply Room by cart
  • Airway Cart
  • Central Line Cart
  • Ortho/splinting Cart
  • Precipitous Delivery (BOA) Cart
  • RME 1-4 Carts
  • Suture Cart
  • Triage Hall Cart
  • Triage Room Carts

Procedures

Special patient types

Others

Patient Disposition

Discharge

  • Follow-up of out patient labs/imaging
    • Any imaging or 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.

(Peterson 11/19)

Admission

OBS & CORE

  • Observation placement
  • CORE placement
  • Observation Patients Direct from UCC
    • Do not need an ED MSE - can go direct to OBS
    • If no OBS beds available in GOLD - should be made Direct Admits to the Hospital

Peterson 8/2019

Other Disposition

Documentation

Disaster & Surge

Resident Education

See Also