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== | ||
* | * Wuhan Coronavirus (nCoV-2019): fever + URI + travel from China in past 14 days | ||
** | **https://www.wikem.org/wiki/Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29 | ||
** for | |||
* iSTAT: as of Sunday 1/26/20, the blue cartridges will be pulled from the floors (Chem 8 & CG4 - lactate, pH, CO2, pO2, HCO3, base excess) | |||
** please use the EC7 as needed (Na, K, iCa, H/H, pH, CO2, pO2, HCO3, base excess) | |||
** You will have to wait for serum lactate from lab | |||
** https://www.pointofcare.abbott/shared/static-assets/other/APOC2020-001%20CHEM8+%20CG4+%20capillary%20and%20CLIA%20notification%20letter%20FINAL.pdf | |||
*New auto-page for Whole Person Care - please page directly for substance abuse issues (not social work) | |||
==General Administrative== | ==General Administrative== | ||
*Pre-hospital | *Pre-hospital | ||
**[[Harbor:Incoming transfers|Incoming transfers]] | **[[Harbor:Incoming transfers|Incoming transfers]] | ||
**Exodus Transfers | |||
***Exodus should call Psych ED about transfer, not Med ED | |||
***Med ED will do MSE | |||
===[[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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====[[Harbor:Paging|Paging consultants]]==== | ====[[Harbor:Paging|Paging consultants]]==== | ||
====[[Harbor:Phone numbers|Phone numbers]]==== | ====[[Harbor:Phone numbers|Phone numbers]]==== | ||
====[[Harbor:Radiology directory|Radiology directory]]==== | |||
===Tests & Orders=== | ===Tests & Orders=== | ||
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**[[Harbor:Ultrasound Approval List|Ultrasound approval list]] | **[[Harbor:Ultrasound Approval List|Ultrasound approval list]] | ||
**[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]] | **[[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 | |||
*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]] | *[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]] | ||
*CT | *CT | ||
**[[Harbor:Ordering a CT|Ordering a CT]] | **[[Harbor:Ordering a CT|Ordering a CT]] | ||
**[[Harbor:ED Radiology Specs|CT Specs]] | **[[Harbor:ED Radiology Specs|CT Specs]] | ||
*Oral contrast | |||
**No more gastrograffin, replaced by omnipaque. Must place an order for it. If you need to obtain a retrograde urethrogram, order a KUB. | |||
**Below is the suggested/usual volume of omnipaque used for certain indication sent to us by Dr. Putnam: | |||
***For use in bowel obstruction, a volume of 100cc of Omnipaque 300 is used. | |||
***For use in tube contrast studies, a volume anywhere between 50-200cc of Omnipaque 300 would likely be used. | |||
***For a CT with po contrast, the order is for 30cc of Omnipaque 300 in 970cc of water. | |||
====[[Harbor:STAT MRI|STAT MRI]]==== | ====[[Harbor:STAT MRI|STAT MRI]]==== | ||
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*Buprenorphine/Opiate Withdrawal Treatment | *Buprenorphine/Opiate Withdrawal Treatment | ||
**[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]] | **[[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)]] | ||
====[[Harbor:ED supplies A-Z|E supplies A-Z]]==== | |||
===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|PE Response Team]] | |||
*[[Harbor:Psych patients|Psych Patients (Exodus)]] | |||
===Others=== | ===Others=== | ||
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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]]''' | |||
*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:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]] | ||
*[[Harbor:Substance Use Disorder|Substance Use Disorder]] | |||
*[[Harbor:Medical Legal Partnership|Medical Legal Partnership]] | *[[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:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]] | *[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]] | ||
*[[Harbor:Home Health|Home Health]] | |||
===Admission | ===Admission=== | ||
*'''[[Harbor:Admission and consultation guidelines|Admission and consultation guidelines]]''' | *'''[[Harbor:Admission and consultation guidelines|Admission and consultation guidelines]]''' | ||
*[[Harbor:Admitting a patient|Admitting a patient]] | *[[Harbor:Admitting a patient|Admitting a patient]] | ||
Line 111: | Line 166: | ||
*[[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]] | ||
Line 133: | Line 192: | ||
==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]] | ||
Line 142: | Line 201: | ||
*[[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== | ||
[[Category:Admin]] | [[Category:Admin]] |
Revision as of 09:22, 24 January 2020
This is the main page for Harbor-UCLA emergency department; See Pediatric ED for the main Harbor pediatric page.
Admin Updates
- Wuhan Coronavirus (nCoV-2019): fever + URI + travel from China in past 14 days
- iSTAT: as of Sunday 1/26/20, the blue cartridges will be pulled from the floors (Chem 8 & CG4 - lactate, pH, CO2, pO2, HCO3, base excess)
- please use the EC7 as needed (Na, K, iCa, H/H, pH, CO2, pO2, HCO3, base excess)
- You will have to wait for serum lactate from lab
- https://www.pointofcare.abbott/shared/static-assets/other/APOC2020-001%20CHEM8+%20CG4+%20capillary%20and%20CLIA%20notification%20letter%20FINAL.pdf
- New auto-page for Whole Person Care - please page directly for substance abuse issues (not social work)
General Administrative
- Pre-hospital
- Incoming transfers
- Exodus Transfers
- Exodus should call Psych ED about transfer, not Med ED
- Med ED will do MSE
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
Radiology directory
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
- Oral contrast
- No more gastrograffin, replaced by omnipaque. Must place an order for it. If you need to obtain a retrograde urethrogram, order a KUB.
- Below is the suggested/usual volume of omnipaque used for certain indication sent to us by Dr. Putnam:
- For use in bowel obstruction, a volume of 100cc of Omnipaque 300 is used.
- For use in tube contrast studies, a volume anywhere between 50-200cc of Omnipaque 300 would likely be used.
- For a CT with po contrast, the order is for 30cc of Omnipaque 300 in 970cc of water.
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
E supplies A-Z
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)
- PE Response Team
- Psych Patients (Exodus)
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
- Home Health
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