Harbor:Main: Difference between revisions
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* [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
* [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
** Visitor Policy:  2 visitors in the ED
** Visitor Policy 4/6/21
*** Must screen neg for COVID questions
**** If Positive screen, ok if with PED or patient who needs assistance (but the visitor must be masked)
**** If positive screen, ok if 2 weeks post-vaccination
*** 2 visitors in the ED


*Transitional Dialysis in the ED/5W,Room10:  [[Harbor:Scheduled_dialysis_patients_in_ED]]  Starting Wednesday, 7/8/2020
* STEMI transfer during cath lab remodel
** 911 IFT - 30 min from door to transfer (unless there happens to be a county ALS unit in our ED ready to go)
** Clerk fax EKG, copies face sheet and
** Call LCM Torrance on radio, fill out STEMI transfer out form
** EMTALA form from patient
** MICN contact 911
** If patient on pressors, sedation for vent, antiarrhythmic gtt --> OCN will find RN/MICN to go with pt (and likely Triage/FT or PED resident)


*[https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines|Updated Admission and Consultation Guidelines - May 2020]
*[https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines|Updated Admission and Consultation Guidelines - May 2020]

Revision as of 15:33, 27 April 2021

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

Admin Updates

  • COVID VACCINES AVAILABLE to ALL PATIENTS: schedule in depart process (black star)
    • Have patient pick a time, then schedule and give them the appointment confirmation page
    • Patient can call x66500 to schedule
    • Can walk in if they have a Harbor MRN (can be OOP)
  • Coronavirus (COVID-19) Info
    • Visitor Policy 4/6/21
      • Must screen neg for COVID questions
        • If Positive screen, ok if with PED or patient who needs assistance (but the visitor must be masked)
        • If positive screen, ok if 2 weeks post-vaccination
      • 2 visitors in the ED
  • STEMI transfer during cath lab remodel
    • 911 IFT - 30 min from door to transfer (unless there happens to be a county ALS unit in our ED ready to go)
    • Clerk fax EKG, copies face sheet and
    • Call LCM Torrance on radio, fill out STEMI transfer out form
    • EMTALA form from patient
    • MICN contact 911
    • If patient on pressors, sedation for vent, antiarrhythmic gtt --> OCN will find RN/MICN to go with pt (and likely Triage/FT or PED resident)

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

Radiology Hours

    • StatRad
      • All studies Fri 4p-Mon 8a with expected TAT<4 hrs
      • Code Strokes after 4p daily
      • Available 24/7 as-needed
      • Reports go directly into FirstNet
      • Faxing prelim during downtime
    • Fortino
      • All X-rays M-F 8a-5p
    • Radiology resident
      • Mon – Thursday 4p - 8a
      • Prelim reads on ED CT, US, MRI
      • Call resident for any XR questions overnight (prelim read), otherwise enter an ED PRELIM and Fortino will over-read in the AM
      • For any XR or CT disagreements overnight, the ED attending can request radiology resident send to StatRad for a final attending read
        • The radiology resident will ask for your name and call-back spectralink and push the radiology study to StatRad

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

Empanelment

  • NERF steps of DHS without empaneled PCP: Primary Care Information tab in Cerner -> New Empanelment -> click any applicable special populations -> Harbor-UCLA MC as requesting facility -> enter any additional pertinent comments -> click box to get email notification once empanelment occurs -> Send NERF request
    • please let patient know they should get a call within 14 days (typically ~72 hours)
  • CCC for specialist and bridge to PCP if DHS without empaneled PCP
  • DHS eligible patient can go to Patient Relations in Rm. 1B1 during business hours to choose a PCP
  • PAC (Patient Access Center) x64400 can follow up to schedule appointments and give updates about e-consults.
  • OOP patients or Out of County patients can call 2-1-1, their insurance card.

ED Follow-Up Clinics

  • 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)

Transportation Needs

  • BUS/METRO TAP CARDS:
    • 8a-5p - send to Social Work Office
    • nights/weekends/holidays - ED RN can get from the House Supervisor x65620 or spectra 23721 who will deliver the voucher to the ED
  • TAXI VOUCHERS: Must have a place to go with keys/someone home, or a shelter where patient is already accepted
    • Daytime - call Social Work to facilitate
    • Night/Weekend/Holidays - call house supervisor x65620 or spectra 23721 who will deliver the voucher to the ED
      • RN calls taxi - must notify taxi if needs wheelchair accessibility (Yellow Cab @ 310-533-6800)
      • RN takes the patient to the hospital nursing office; taxi driver comes to nursing office to sign paperwork and pick up the patient
  • UBER/LYFT:
    • Similar to above Taxi Vouchers
    • Available to patient's without insurance who do not have other transportation options
  • AMBULANCE: for patients that have a medical necessity (cannot ambulate, here w/o wheel chair, etc) and medically cannot take a taxi
  • ED RN & area clerk to coordinate with insurance (if applicable)
  • If patient is UNINSURED (including restricted Medi-cal) - use county transport to get an ambulance home
    • UR & SW can get involved if issues
    • If patient lives outside of LA County, call nursing supervisor or SW as they may need further authorization
      • Joy Lagrone can authorize county transport as a last resort
  • kids without car seats: For kids who arrive (usually by ambulance) w/o a car seat, we do not have car seats available. however, options are:
  1. take the bus home (no need for car seat)
  2. have someone bring a car seat and pick them up or go home in a taxi with the car seat that is brought
  3. if a. or b. will not work, can try arranging for ambulance (see section above)

Social EM resources

  • Harbor Social Work
    • 24/7 Auto page in house social worker p1735 for various issues including: homelessness, discharge planning, sexual assault, crisis/grief, suspected elder/child abuse, recoup care, disability benefits (SSI), etc.
  • Homeless Task Force, in person during business hours 730a-4p Mon-Fri pager # is (310) 501-0637 and their phone number is (310) 413-8871
  • Opiate Withdrawal/MAT/BUP
  • Medical Legal Partnership
  • Immigration Assistance
  • Hospital Based Violence Intervention Program and Trauma Recovery Center
  • Whole Person Care (WPC) autopage in Cerner, p0145, refer 24/7.
    • Substance use disorders (SUD)
      • Available SUD counselor in person Mon 8a-5p, T-F 8a-1230a, Sat 4p-1230a.
      • Otherwise will follow up next business day via phone call. Need good contact phone number. Ensure patient knows you put a referral and someone will be contacting them.
      • On discharge, include the WPC discharge instructions (“Whole Person Care Harbor-UCLA”, also available in Spanish) from ORCHID
    • Medically Complex Transitions of care (includes 3 visits to ED in past year)
      • 1) ORCHID Message/Call/Text Lelalee Vicedo - Social Work Supervisor. Please include MRN, pt phone number, and reason for referral. (213) 572-9895. She will respond M-F 9:00-4:30 pm but you can ORCHID message/call/text/email anytime.
      • AND 2) place order in ORCHID: Consult to Social Work: reason for referral = other, free text WPC TOC
  • Re-entry (released from prison <6 months with medical, mental health, substance abuse, or social needs) 844.804.5200 (24/7) and put patient on phone.
  • Food Pharmacy, free fruits and vegetables every Wednesday 9a-1p outside front entrance of S/E building
  • Free cell phones:
    • Lifeline free phones: Outside of S/E building 8a-6p (Monday - Sat)
    • Social work has a limited number
  • Mental Health
    • Residential & Bridging Care (transition from mental health institution to community) 213.738.4775
    • Intensive Service Recipients (mental health with 2 or more admissions in year, recent DC from psych hospital) 844.804.5200
  • Perinatal (high-risk pregnant mothers - homeless, mental health, substance abuse, domestic violence, no food) Mama's Program844.376.2627

Admission

Admission Guidelines

Interqual Override Notes

Right level of care

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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