Harbor:Main: Difference between revisions

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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


==General Administrative==
==General Administrative==
*Pre-hospital
*Pre-hospital
**[[Harbor:Incoming transfers|Incoming transfers]]
**[[Harbor:Incoming transfers|Incoming transfers]]
**[[Harbor:Screening EMS Patients|Screening EMS Patients]]
===[[Harbor:Screening EMS Patients|Screening EMS Patients]]===
**[[Harbor: Triaging Ambulance Runs|Triaging Ambulance Runs]]
===Administrative duties===
*Administrative duties
**[[Harbor:Administrative resident|Administrative resident directions]]
**[[Harbor:Administrative resident|Administrative resident directions]]
**[[Harbor: Phone Calls|Receiving Phone Calls]]
**[[Harbor: Phone Calls|Receiving Phone Calls]]
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**[[Harbor:EKG screening|EKG Screening]]
**[[Harbor:EKG screening|EKG Screening]]
**[[Harbor:5S|Pre-shift: 5S]]
**[[Harbor:5S|Pre-shift: 5S]]
*Administrative resources
**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:Core Measures|Core Measures]]
**[[Harbor:ED policy manual|Harbor ED policy manual]]
**[[Harbor:ED policy manual|Harbor ED policy manual]]
**[[Harbor:RME & TRIAGE|RME & triage]]
**[[Harbor:ED attending on call plan|ED attending on call plan]]
**[[Harbor:ED attending on call plan|ED attending on call plan]]
**[[Harbor:Legal|Harbor Legal]]
**[[Harbor:Legal|Harbor Legal]]
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==Managing your Patient==
==Managing your Patient==
===General===
===General===
*[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]
====[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]====
*[[Harbor:Phone numbers|Phone numbers]]
====[[Harbor:Paging|Paging consultants]]====
*[[Harbor:Forms|Forms]]
====[[Harbor:Phone numbers|Phone numbers]]====
 


===Tests & Orders===
===Tests & Orders===
*[[Harbor:Labs|Labs]]
*[[Harbor:Labs|Labs]]
*Radiology
*Radiology
**Ultrasound
====[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]====
***[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
*Ultrasound
***[[Harbor:Ultrasound Approval List|Ultrasound approval list]]
**[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
***[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
**[[Harbor:Ultrasound Approval List|Ultrasound approval list]]
**[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
**[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
**CT
**Cleaning Endocavitary Probes
***[[Harbor:Ordering a CT|Ordering a CT]]
***Place in Red Bag (above probe cabinet in clean utility room)
***[[Harbor:ED Radiology Specs|CT Specs]]
***Place patient sticker on bag
**MRI
***Give to area charge nurse
***[[Harbor:STAT MRI|STAT MRI]]
***Once cleaned, probe comes back in clear bag
***[[Harbor:ED Radiology Specs|MRI Specs]]
***T. Jang 8/2019
 
*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
*CT
**[[Harbor:Ordering a CT|Ordering a CT]]
**[[Harbor:ED Radiology Specs|CT Specs]]
 
====[[Harbor:STAT MRI|STAT MRI]]====
*[[Harbor:ED Radiology Specs|MRI Specs]]
*Other orders
*Other orders
**[[Harbor:Ordering Blood Products|Blood products]]
**[[Harbor:Ordering Blood Products|Blood products]]
**Antibiotics
**Antibiotics
***[[Harbor:Antibiogram|Harbor antibiogram]]
***[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
****[[Harbor:Sepsis core measures|Sepsis core measures]]


===Consults===
====[[Harbor:Antibiogram|Antibiogram]]====
*[[Harbor:Phone numbers|Phone numbers]]
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
*[[Harbor:Paging|Paging consults]]
***[[Harbor:Sepsis core measures|Sepsis core measures]]
*[[Harbor:Social work|Social work]]
*Buprenorphine/Opiate Withdrawal Treatment
*[[Harbor:Whole person care|Whole person care]]
**[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
 
==== 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===
*[[Harbor:Equipment|Equipment (AED/RME)]]
*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
*[[Harbor:DME|Durable Medical 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
**[[File:WikEM1.jpg|400px]]
**[[File:WikEM2.jpg|400px]]
**[[File:WikEM3.jpg|400px]]
**[[File:WikEM4.jpg|400px]]
*Main Supply Room by cart


===Finding Things===
*Airway Cart
*[[Harbor:Forms|Forms]]
*Central Line Cart
*Equipment
*Ortho/splinting Cart
**[[Harbor:Equipment|Equipment (AED/RME)]]
*Precipitous Delivery (BOA) Cart
**[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
*RME 1-4 Carts
**[[Harbor:DME|Durable Medical Equipment (DME)]]
*Suture Cart
*[[Harbor:Phone numbers|Phone numbers]]
*Triage Hall Cart
*Triage Room Carts


===Procedures===
===Procedures===
*[[Harbor:Consenting a patient|Consenting a patient]]
*[[Harbor:Consenting a patient|Consenting a patient]]
*[[Harbor:Equipment|Equipment (AED/RME)]]
*[[Harbor:Procedures Videos|Procedure Videos]]


==Special patient types==
==Special patient types==
*[[Harbor:Whole person care|Whole person care]]
*[[Harbor:Social work|Social work]]
*Activations
*Activations
**[[Harbor:Codes|Code Activations]]
***[[Harbor:Involuntary holds|Involuntary holds]]
**[[Harbor:Airway management team|Airway management team]]
**[[Harbor:Airway management team|Airway management team]]
**[[Harbor:Code stroke|Code Stroke]]
**[[Harbor:Code stroke|Code Stroke]]
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**[[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]]
*Others
*'''[[Harbor:Occupational exposure|Occupational Exposure]]'''
**[[Harbor:AVF/graft complications|AVF/graft complications]]
*[[Harbor:Industrial Accident (IA)|Industrial or On-the-Job Accidents (IA)]]
**[[Harbor:Respiratory isolation|Respiratory isolation]]
*'''[[Harbor:Non-Occupational Exposure|Sexual Assault/STI Exposure (SART)]]'''
**[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]
*[[Harbor:PE Response Team]]
**Exposures
 
***[[Harbor:Occupational exposure|Occupational Exposure]]
===Others===
***[[Harbor:Industrial Accident (IA)|Industrial or On-the-Job Accidents (IA)]]
*[[Harbor:AVF/graft complications|AVF/graft complications]]
***[[Harbor:Non-Occupational Exposure|Sexual Assault/STI Exposure]]
*[[Harbor:Respiratory isolation|Respiratory isolation]]
*[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
**[[Harbor:Ebola|Suspected Ebola protocol]]
*[[Harbor:Replantation Patients|Replantation Patients]]
*[[Harbor:XRT|XRT transfers]]


==Patient Disposition==
==Patient Disposition==
===[[Harbor:Discharge|Discharging a Patient]]===
===Discharge===
*[[Harbor:Prescribing|Prescribing]]
*[[Harbor: ED Follow-Up Options|ED Follow-Up]]
*[[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]
**[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]]'''
*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)
*[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
*[[Harbor:Substance Use Disorder|Substance Use Disorder]]
*[[Harbor:Medical Legal Partnership|Medical Legal Partnership]]
*[[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:Coumadin clinic|Coumadin clinic]]
*[[Harbor:Expedited workup clinic|Expedited workup clinic]]
*[[Harbor:Expedited workup clinic|Expedited workup clinic]]
*[[Harbor:Prescribing|Prescribing]]
*[[Harbor: ED Follow-Up Options|ED Follow-Up Clinics]]
*[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]]
*[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]]
*[[Harbor:Prescribing|Prescribing]]


===Admission, OBS, & CORE ===
===Admission===
*'''[[Harbor:Admission and consultation guidelines|Admission and consultation guidelines]]'''
*[[Harbor:Admitting a patient|Admitting a patient]]
*[[Harbor:Admitting a patient|Admitting a patient]]
**[[Harbor:Admission and consultation guidelines|Admission and consultation guidelines (Who goes to what service; policy 312)]]
*[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
***[[Harbor:Right level of care|Right level of care]]
*[[Harbor:Right level of care|Right level of care]]
***[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
*[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
***[[Harbor:C-Team|C-Team Admissions]]
*[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]]
***[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
*[[Harbor:Direct Admission after Hours|Direct Admission after Hours]]
**[[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
*[[Harbor:Paging|Paging consultants]]
**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===
===Other Disposition===
*[[Harbor:Deceased patients|Deceased patients]]
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
* [[Harbor:Deceased patients|Deceased patients]]
*[[Harbor:Transferring a patient|Transferring a patient]]
*[[Harbor:Transferring a patient|Transferring a patient]]
**[[Harbor:Transferring to psych ER|Transferring to psych ER]]
**[[Harbor:Transferring to psych ER|Transferring to psych ER]]
**[[Harbor:XRT|XRT transfers]]
**[[Harbor:Replantation Patients|Replantation patient transfer]]


==Documentation==
==Documentation==
*[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]
**[[Harbor: Macros and Autotext|Macros and Autotext]]
*[[Harbor:Attending documentation|Attending Documentation]]
*[[Harbor:Attending documentation|Attending Documentation]]
*[[Harbor:Resident documentation|Resident documentation]]
*[[Harbor:Resident documentation|Resident documentation]]
*[[Harbor:Prescribing|Prescribing]]
*[[Harbor:Consenting a patient|Consenting a Patient]]
*[[Harbor:Codes|Codes]]
*[[Harbor: Macros and Autotext|Macros and Autotext]]
*[[Harbor: Consenting a Patient|Consenting a Patient]]
**[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]
**[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]
*[[Harbor:Forms|Forms]]


==Disaster==
==Disaster & Surge==
*[[Harbor:Disaster info|General disaster info]]
*[[Harbor:Disaster plan|Disaster plan]]
*[[Harbor:Surge plan|Surge plan]]
*'''[[Harbor:Surge plan|Surge plan]]'''
*[[Harbor:Ebola|Suspected Ebola protocol]]
*[[Harbor:Surge Plan/Disasters|Harbor Surge Plan/Disasters]]
*[[Harbor:Disaster plan|Harbor disaster plan]]
*[[Harbor:ORCHID Downtime|ORCHID Downtime]]
*[[Harbor:ORCHID Downtime|ORCHID Downtime]]
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
**[[Harbor:Ebola|Suspected Ebola protocol]]


==Resident Education==
==Resident Education==
Line 137: Line 205:
*[[Harbor:VA MICU rotation|VA MICU rotation]]
*[[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:How to get started in research at Harbor|How to get started in research at Harbor]]
*[[Harbor:Jeopardy Policy|Jeopardy Policy]]


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

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