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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!
* 7/7/2020 - We are in ED COVID Surge 1 [[Infectious_Disease_Threats#Covid_Surge_Plan|COVID Surge Plan]]
** [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
 
*Transitional Dialysis in the ED/5W,Room10:  [[Harbor:Scheduled_dialysis_patients_in_ED]]  Starting Wednesday, 7/8/2020
 
*GOLD closed for ED use. Only for inpatient boarders
 
*OBS Update (6/2/2020) - for patients being admitted to the new '''short-stay medicine team, page the ED hospitalist at 204-9753, order "PLACE IN OBS" (just like we did pre-COVID)'''; the medicine team will order the "request for admit" once they get the COVID test results.  Drs. Spiegel & Chappell
 
*[https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines|Updated Admission and Consultation Guidelines - May 2020]
 
* Whole Blood coming 5/11 (ED fridge) - limited to use for trauma patients, 2 units max per patient
 
* 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


==General Administrative==
==General Administrative==
*[[Harbor:Administrative resident|Administrative resident directions]]
*[[Harbor: Phone Calls|Receiving Phone Calls]]
**[[Harbor:Critical Result Callback]]
*[[Harbor: Triaging Ambulance Runs|Triaging Ambulance Runs]]
*[[Harbor:EKG screening|EKG Screening]]
*[[Harbor:5S|Pre-shift: 5S]]
*[[Harbor:Legal]]
*Pre-hospital
*Pre-hospital
**[[Harbor:Incoming transfers|Incoming transfers]]===
**[[Harbor:Incoming transfers|Incoming transfers]]
**[[Harbor:Screening EMS Patients|Screening EMS Patients]]
**Exodus Transfers
***Exodus should call Psych ED about transfer, not Med ED
***Med ED will do MSE
===[[Harbor:Screening EMS Patients|Screening EMS Patients]]===
===Administrative duties===
**[[Harbor:Administrative resident|Administrative resident directions]]
**[[Harbor: Phone Calls|Receiving Phone Calls]]
***[[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]]
**[[Harbor:Ophtho abbreviation dictionary]]


==Managing your Patient==
==Managing your Patient==
===Ordering & Testing===
===General===
*[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
====[[Harbor:PC Cheat Sheet|On shift (PC) Cheat Sheet]]====
*[[Harbor:Ultrasound Approval List|Ultrasound approval list]]
 
*[[Harbor:Ordering a CT|Ordering a CT]]
====[[Harbor:Paging|Paging consultants]]====
*[[Harbor:Ordering Blood Products|Ordering Blood Products]]
====[[Harbor:Phone numbers|Phone numbers]]====
*Ordering antibiotics
====[[Harbor:Radiology directory|Radiology directory]]====
**[[Harbor:Antibiogram|Harbor antibiogram]]
 
===Tests & Orders===
*[[Harbor:Labs|Labs]]
*Radiology
====[[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]]
**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]]
 
*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:ED Radiology Specs|MRI Specs]]
*Other orders
**[[Harbor:Ordering Blood Products|Blood products]]
**Antibiotics
 
====[[Harbor:Antibiogram|Antibiogram]]====
**[[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:Labs|Labs]]
*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


===Radiology===
===Finding Equipment/DME===
*[[Harbor:ED Radiology Specs|MRI Specs]]
*[[Harbor:Equipment|Equipment (AED/RME)]]
*[[Harbor:ED Radiology Specs|CT Specs]]
*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
*[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
*[[Harbor:DME|Durable Medical Equipment (DME)]]
*[[Harbor:STAT MRI|STAT MRI]]
*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]


===Documenting===
====[[Harbor:ED supplies A-Z|E supplies A-Z]]====
*[[Harbor:Attending documentation|Attending documentation]]
*[[Harbor: Consenting a Patient|Consenting a Patient]]
*[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]
*[[Harbor: Macros and Autotext]]


===Procedures===
===Procedures===
*[[Harbor:Equipment|Equipment]]
*[[Harbor:Consenting a patient|Consenting a patient]]
*[[Harbor:Consenting a patient|Consenting a patient]]
 
*[[Harbor:Procedures Videos|Procedure Videos]]
===Finding Things===
*[[Harbor:Forms|Forms]]
*[[Harbor:Paging|Paging consults]]
*Equipment
**[[Harbor:Equipment|Equipment (AED/RME)]]
**[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
**[[Harbor:DME|Durable Medical Equipment (DME)]]


==Special patient types==
==Special patient types==
*[[Harbor:Occupational exposure|Occupational exposure]]
*[[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
*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]]
*'''[[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|PE Response Team]]
*[[Harbor:Psych patients|Psych Patients (Exodus)]]
 
===Others===
*[[Harbor:AVF/graft complications|AVF/graft complications]]
*[[Harbor:AVF/graft complications|AVF/graft complications]]
*[[Harbor:Respiratory isolation|Respiratory isolation]]
*[[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===
*[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]]
*[[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]]'''
*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:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]]
*[[Harbor:Home Health|Home Health]]


===Admission, OBS, & CORE ===
===Admission===
====[[Harbor:Admission and consultation guidelines|Admission 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


===[[Harbor:Scheduled_dialysis_patients_in_ED|Dialysis in the ED]]===
===Other Disposition===
===Other Disposition===
*[[Harbor:Deceased patients|Deceased patients]]
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
*[[Harbor:Administrative resident|Transfers]]
* [[Harbor:Deceased patients|Deceased patients]]
 
==[[Harbor:Disaster info|Disaster]]==
*[[Harbor:Disaster info|General disaster info]]
*[[Harbor: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:Infectious Disease Threats|Infectious Disease Threats]]
 
==See Also==
*[[Harbor:Main]]
*[[Harbor:VA MICU rotation]]
*[[Harbor:Teaching Rounds Topics]]
*[[Harbor:How to get started in research at Harbor]]
*[[Harbor:RME Manual]]
*[[Harbor:Code STEMI]]
 
 
[[Category:Admin]]
 
==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==
===F/up Flowchart===
* 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:Discharge|Law Enforcement Escort]]===
*[[Harbor:Prescribing|Prescribing]]
 
===Other===
*[[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]]
==Physicians==
**[[Harbor:Replantation Patients|Replantation patient transfer]]
===[[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==
{{Special:Prefixindex/Harbor |hideredirects=1}}


===[[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 06:38, 8 July 2020

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

Admin Updates

  • GOLD closed for ED use. Only for inpatient boarders
  • OBS Update (6/2/2020) - for patients being admitted to the new short-stay medicine team, page the ED hospitalist at 204-9753, order "PLACE IN OBS" (just like we did pre-COVID); the medicine team will order the "request for admit" once they get the COVID test results. Drs. Spiegel & Chappell
  • Whole Blood coming 5/11 (ED fridge) - limited to use for trauma patients, 2 units max per patient

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

RME & triage

Managing your Patient

General

On shift (PC) Cheat Sheet

Paging consultants

Phone numbers

Radiology directory

Tests & Orders

Enter Prelim Rads Read

  • 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

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

E supplies A-Z

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

Admission Guidelines

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

Dialysis in the ED

Other Disposition

Documentation

Disaster & Surge

Resident Education

See Also

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