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==
*Radiology Discrepancy Process
* 7/7/2020 - We are in ED COVID Surge 1 [[Infectious_Disease_Threats#Covid_Surge_Plan|COVID Surge Plan]]
** Please enter a prelim read on ALL unread imaging (XR, US, CT without prelim or final read) so radiology knows to call if we missed something
** [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
** In Synapse "notes" section write the following and "add"
*** "ED PRELIM [Your findings] [Your Name] [Your Spectra link Number]"
*** I.e., ED PRELIM - Fracture R distal radius. Peterson 23202
* The 7am Triage Resident will review any discrepancies daily. 
** Go to Synapse --> DHS Enterprise Synapse --> Conferences --> Critical Findings --> ED Discrepancy
*** Open "preliminary" studies to view the discrepancy notes from the radiologist
*** If unclear of significance, ask an attending
*** If acting on discrepancy, please document a free-text "Imaging Follow-up" note and include the study type and date
**** I.e., "CXR on 8/15/17" demonstrated 6mm pulm nodule; messaged PCP to ensure f/up
*** When finished with f/up, change the status in synapse by right-clicking on "preliminary" --> "shortcut status" --> "complete"
*** If no action is needed, comment in the synapse notes section "Case reviewed - No follow-up required" and put your name.


*Transitional Dialysis in the ED/5W,Room10:  [[Harbor:Scheduled_dialysis_patients_in_ED]]  Starting Wednesday, 7/8/2020


Sample Note when follow-up is needed:
*GOLD closed for ED use. Only for inpatient boarders
This goes in CERNER


"Imaging Follow-up
*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


Head CT from 7/31/18 referred for follow-up on 8/1/18. Small subdural hematoma seen. Patient called and agrees to return to ED today. Discussed with M. Peterson"
*[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)
Sample Note when no follow-up required:
** please use the EC7 as needed (Na, K, iCa, H/H, pH, CO2, pO2, HCO3, base excess)
This goes in SYNAPSE Notes section for the exact study:
** 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
"Case reviewed - No follow-up required. Discussed with M. Peterson. Jane Doe, NP"
 
Note than in SYNAPSE no need to state type or date of study as you will be entering comments directly on that study. You DO need to put your name as your name is not automatically added in synapse.
 
 
2/25/19 - Peterson


==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]]
**Exodus Transfers
**[[Harbor: Triaging Ambulance Runs|Triaging Ambulance Runs]]
***Exodus should call Psych ED about transfer, not Med ED
*Administrative duties
***Med ED will do MSE
===[[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: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]]
**[[Harbor:Ophtho abbreviation dictionary]]


==Managing your Patient==
==Managing your Patient==
===General===
===General===
*[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]
====[[Harbor:PC Cheat Sheet|On shift (PC) Cheat Sheet]]====
*[[Harbor:Phone numbers|Phone numbers]]
 
*[[Harbor:Forms|Forms]]
====[[Harbor:Paging|Paging consultants]]====
====[[Harbor:Phone numbers|Phone numbers]]====
====[[Harbor:Radiology directory|Radiology directory]]====


===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]]
 
*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
*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)]]


===Finding Things===
====[[Harbor:ED supplies A-Z|E supplies A-Z]]====
*[[Harbor:Forms|Forms]]
*Equipment
**[[Harbor:Equipment|Equipment (AED/RME)]]
**[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
**[[Harbor:DME|Durable Medical Equipment (DME)]]
*[[Harbor:Phone numbers|Phone numbers]]


===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]]
*[[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:Codes|Code Activations]]
Line 110: Line 132:
**[[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]]
**Exposures
*'''[[Harbor:Occupational exposure|Occupational Exposure]]'''
***[[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:Non-Occupational Exposure|Sexual Assault/STI Exposure]]
*[[Harbor:PE Response Team|PE Response Team]]
*Others
*[[Harbor:Psych patients|Psych Patients (Exodus)]]
**[[Harbor:AVF/graft complications|AVF/graft complications]]
 
**[[Harbor:Respiratory isolation|Respiratory isolation]]
===Others===
**[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]
*[[Harbor:AVF/graft complications|AVF/graft complications]]
**[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
*[[Harbor:Respiratory isolation|Respiratory isolation]]
***[[Harbor:Ebola|Suspected Ebola protocol]]
*[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]
**[[Harbor:Replantation Patients|Replantation Patients]]
*[[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: ED Follow-Up Options|ED Follow-Up Clinics]]'''
***[[Harbor:Coumadin clinic|Coumadin clinic]]
*'''[[Harbor:Forms|Forms]]'''
***[[Harbor:Expedited workup clinic|Expedited workup clinic]]
 
*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: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, OBS, & CORE ===
===Admission===
*[[Harbor:Paging|Paging consultants]]
====[[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:C-Team|C-Team Admissions]]
*[[Harbor:Right level of care|Right level of care]]
***[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
*[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
**[[Harbor:Right level of care|Right level of care]]
*[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]]
**[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
*[[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
**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: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==
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*[[Harbor:Consenting a patient|Consenting a Patient]]
*[[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 & Surge==
==Disaster & Surge==
*[[Harbor:Disaster plan|Disaster plan]]
*[[Harbor:Disaster plan|Disaster plan]]
*[[Harbor:Surge plan|Surge 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==
*[[Harbor:RME Manual]]
{{Special:Prefixindex/Harbor |hideredirects=1}}


[[Category:Admin]]
[[Category:Admin]]

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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