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.'' | ||
==Admin Updates== | ==Admin Updates== | ||
*PERT (PE Response Team) | *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 | ** 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 | ** for details: https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Pulmonary_Embolus | ||
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**[[Harbor:Incoming transfers|Incoming transfers]] | **[[Harbor:Incoming transfers|Incoming transfers]] | ||
===[[Harbor:Screening EMS Patients|Screening EMS Patients]]=== | ===[[Harbor:Screening EMS Patients|Screening EMS Patients]]=== | ||
===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: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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*Radiology | *Radiology | ||
====[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]==== | ====[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]==== | ||
*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]] | |||
**[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]] | **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 | |||
*[[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: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|Antibiogram]]==== | ====[[Harbor:Antibiogram|Antibiogram]]==== | ||
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]] | |||
***[[Harbor:Sepsis core measures|Sepsis core measures]] | |||
*Buprenorphine/Opiate Withdrawal Treatment | |||
**[[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=== | ===Finding Equipment/DME=== | ||
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*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]] | *[[Harbor:Equipment and supplies (peds)|Equipment (peds)]] | ||
*[[Harbor:DME|Durable Medical Equipment (DME)]] | *[[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 | |||
*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=== | ===Procedures=== | ||
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==Special patient types== | ==Special patient types== | ||
*[[Harbor:Whole person care|Whole person care]] | |||
*[[Harbor:Social work|Social work]] | *[[Harbor:Social work|Social work]] | ||
*Activations | *Activations | ||
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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]] | ||
*'''[[Harbor:Occupational exposure|Occupational Exposure]]''' | |||
*[[Harbor:Industrial Accident (IA)|Industrial or On-the-Job Accidents (IA)]] | *[[Harbor:Industrial Accident (IA)|Industrial or On-the-Job Accidents (IA)]] | ||
*'''[[Harbor:Non-Occupational Exposure|Sexual Assault/STI Exposure (SART)]]''' | |||
*[[Harbor:PE Response Team]] | |||
===Others=== | |||
*[[Harbor:AVF/graft complications|AVF/graft complications]] | |||
*[[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== | ||
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*[[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]]''' | |||
***[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]] | |||
* | *Follow-up of out patient labs/imaging | ||
***[[Harbor:Coumadin clinic|Coumadin clinic]] | **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:Expedited workup clinic|Expedited workup clinic]] | |||
*[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]] | *[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]] | ||
===Admission | ===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:Who Goes to Family Medicine|Who Goes to Family Medicine]] | *[[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:Internal Medicine Admissions|Internal Medicine Admission Template]] | ||
*[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]] | *[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]] | ||
*[[Harbor:Direct Admission after Hours|Direct Admission after Hours]] | *[[Harbor:Direct Admission after Hours|Direct Admission after Hours]] | ||
===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 | |||
===Other Disposition=== | ===Other Disposition=== | ||
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]] | |||
* [[Harbor:Deceased patients|Deceased patients]] | * [[Harbor:Deceased patients|Deceased patients]] | ||
*[[Harbor:Transferring a patient|Transferring a patient]] | *[[Harbor:Transferring a patient|Transferring a patient]] | ||
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==Disaster & Surge== | ==Disaster & Surge== | ||
*[[Harbor:Disaster plan|Disaster plan]] | *[[Harbor:Disaster plan|Disaster plan]] | ||
*'''[[Harbor:Surge plan|Surge 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]] | ||
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*[[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])
- 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
- Pre-hospital
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
- Labs
- Radiology
Enter Prelim Rads Read
- Ultrasound
- Ordering a Formal Ultrasound
- Ultrasound approval list
- 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
STAT MRI
- MRI Specs
- Other orders
- Blood products
- Antibiotics
Antibiogram
- Buprenorphine/Opiate Withdrawal Treatment
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
- 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
- Whole person care
- Social work
- Activations
- Sepsis
- Occupational Exposure
- Industrial or On-the-Job Accidents (IA)
- Sexual Assault/STI Exposure (SART)
- Harbor:PE Response Team
Others
- AVF/graft complications
- Respiratory isolation
- Scheduled dialysis patients in ED
- Infectious Disease Threats
- Replantation Patients
- XRT transfers
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)
- Opiate Withdrawal/MAT/BUP
- Substance Use Disorder
- Medical Legal Partnership
- Immigration Assistance
- Hospital Based Violence Intervention Program and Trauma Recovery Center
- Coumadin clinic
- Expedited workup clinic
- Law Enforcement Discharge Escort
Admission
- Admission and consultation guidelines
- Admitting a patient
- Who Goes to Family Medicine
- Right level of care
- Internal Medicine Admission Template
- Post-admission management/Orders on Admitted Patients
- Direct Admission after Hours
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