Harbor:Main: Difference between revisions
Line 1: | Line 1: | ||
''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== | ||
* COVID VACCINES AVAILABLE to ALL PATIENTS: schedule in depart process (black star) | * '''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 | ** Have patient pick a time, then schedule and give them the appointment confirmation page | ||
** Patient can call x66500 to schedule | ** Patient can call x66500 to schedule | ||
Line 7: | Line 7: | ||
* [[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 4/6/21 | ** '''Visitor Policy''' 4/6/21 | ||
*** Must screen neg for COVID questions | *** 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 with PED or patient who needs assistance (but the visitor must be masked) | ||
**** If positive screen, ok if 2 weeks post-vaccination | **** If positive screen, ok if 2 weeks post-vaccination | ||
*** 2 visitors in the ED | *** '''2 visitors in the ED''' | ||
* STEMI transfer during cath lab remodel | * '''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) | ** '''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 | ** Clerk fax EKG, copies face sheet and | ||
** Call LCM Torrance on radio, fill out STEMI transfer out form | ** Call LCM Torrance on radio, fill out STEMI transfer out form |
Revision as of 15:34, 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
- Must screen neg for COVID questions
- Visitor Policy 4/6/21
- 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
- StatRad
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)
- Harbor: Identifying Jane/John Doe, finding next of kin tips
Others
- AVF/graft complications
- Respiratory isolation
- Scheduled dialysis patients in ED
- Infectious Disease Threats
- Replantation Patients
- XRT transfers
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)
- Coumadin clinic
- Expedited workup clinic
- Law Enforcement Discharge Escort
- Home Health
- Harbor:Home hospice from ED
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:
- take the bus home (no need for car seat)
- have someone bring a car seat and pick them up or go home in a taxi with the car seat that is brought
- 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
- Substance use disorders (SUD)
- 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
- 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
Dialysis in the ED
Other Disposition
Documentation
Disaster & Surge
Resident Education
See Also
- Harbor-UCLA
- Harbor:5S
- Harbor:911 STEMI out
- Harbor:AB 2760: Naloxone for patients at risk for opioid overdose
- Harbor:AVF/graft complications
- Harbor:Administrative resident
- Harbor:Admission and consultation guidelines
- Harbor:Admitting a patient
- Harbor:Adults
- Harbor:Adults results/symptom phone follow up
- Harbor:Adverse event mandatory reporting
- Harbor:Airway management team
- Harbor:Alcohol Use Disorder/Withdrawal Treatment
- Harbor:Antibiogram
- Harbor:Attending documentation
- Harbor:BUP
- Harbor:Baby Safe Surrender Program
- Harbor:Burns
- Harbor:CCC
- Harbor:CORE
- Harbor:Code STEMI
- Harbor:Code stroke
- Harbor:Codes
- Harbor:Consenting a patient
- Harbor:Consultation of subspecialists (peds)
- Harbor:Core Measures
- Harbor:Coroners' case
- Harbor:Coumadin clinic
- Harbor:Creatinine screening prior to IV contrast
- Harbor:Critical Result Callback
- Harbor:Crown Checks in PED
- Harbor:DC with meds in ED
- Harbor:DEM Admin on Duty (AOD)
- Harbor:DHS-Eligible patient needing Primary Care
- Harbor:DHS Visitor Policy
- Harbor:DME
- Harbor:Death Packet Checklist
- Harbor:Deceased patients
- Harbor:Direct Admission after Hours
- Harbor:Direct book without consultant discussion
- Harbor:Disaster plan
- Harbor:Discrepancy Review Process
- Harbor:Diversion for ALS and BLS
- Harbor:ED Radiology Specs
- Harbor:ED attending on call plan
- Harbor:ED follow-up options
- Harbor:ED policy manual
- Harbor:ED supplies A-Z
- Harbor:EKG screening
- Harbor:Ebola
- Harbor:Empiric antibiotics
- Harbor:Endocavitary Probes
- Harbor:Entering Prelim Radiology Read
- Harbor:Equipment
- Harbor:Equipment and supplies (peds)
- Harbor:Example text for a discrepancy e-mail
- Harbor:Exodus
- Harbor:Expedited Work-up Clinic (EWC)
- Harbor:Expedited workup clinic
- Harbor:Forms
- Harbor:Hip fractures
- Harbor:Home Health
- Harbor:Home hospice from ED
- Harbor:Hospital Based Violence Intervention Program and Trauma Recovery Center
- Harbor:How to NERF
- Harbor:How to get started in research at Harbor
- Harbor:How to submit CCC referral
- Harbor:Immigration Legal Assistance
- Harbor:Incoming transfers
- Harbor:Industrial Accident (IA)
- Harbor:Infectious Disease Threats
- Harbor:Instructions for clerk requesting/booking an appointment
- Harbor:Insurance Codes
- Harbor:Internal Medicine Admissions
- Harbor:Interqual Criteria Tips
- Harbor:Interqual Override Notes
- Harbor:Involuntary holds
- Harbor:Jeopardy Policy
- Harbor:Labs
- Harbor:Law Enforcement Discharge Escort
- Harbor:Legal
- Harbor:MAC Transfer Burn or Replant
- Harbor:Main
- Harbor:Medical Legal Partnership
- Harbor:NERF
- Harbor:NFL Injured Player/Staff Protocol
- Harbor:Non-Occupational Exposure
- Harbor:OOP follow up options
- Harbor:ORCHID Downtime
- Harbor:Observation placement
- Harbor:Occupational exposure
- Harbor:Occupational exposure (dot-phrases)
- Harbor:Opiate Withdrawal/MAT/BUP
- Harbor:Options for follow-up (peds)
- Harbor:Oral contrast
- Harbor:Ordering Blood Products
- Harbor:Ordering a CT
- Harbor:Ordering a Formal Ultrasound
- Harbor:PC Cheat Sheet
- Harbor:PED psych patients
- Harbor:PE Response Team
- Harbor:Paging
- Harbor:Patient wants to switch to Harbor
- Harbor:Pediatric:Subspecialties
- Harbor:Pediatric ED (main)
- Harbor:Pediatric admission guidelines
- Harbor:Pediatric antibiotics
- Harbor:Pediatrics CCS Follow up
- Harbor:Peds
- Harbor:Peds ED follow-up track information
- Harbor:Peds ED schedule and sick backup plans
- Harbor:Peds results/symptom phone follow up
- Harbor:Phone numbers
- Harbor:Placement patients
- Harbor:Post-admission management
- Harbor:Prescribing
- Harbor:Primary Care
- Harbor:Procedures Videos
- Harbor:Psych patients
- Harbor:QR for Patients
- Harbor:QR for Staff
- Harbor:RME & TRIAGE
- Harbor:RME Manual
- Harbor:Radiology Hours
- Harbor:Radiology directory
- Harbor:Receiving phone calls
- Harbor:Replantation Patients
- Harbor:Resident Documentation
- Harbor:Resident documentation
- Harbor:Resident responsibilities and transitions of responsibility
- Harbor:Respiratory isolation
- Harbor:Right level of care
- Harbor:Rules for Performing ED Ultrasounds
- Harbor:SB 1152 - 2019 California homeless patient discharge planning law
- Harbor:STAT MRI
- Harbor:STEMI 911 Inter-Facility Transfer (IFT)
- Harbor:Same/Next Day Specialty Clinic Follow up
- Harbor:Sandbox
- Harbor:Scheduled dialysis patients in ED
- Harbor:Screening EMS Patients
- Harbor:Sepsis antibiotics
- Harbor:Sepsis core measures
- Harbor:Sexual assault
- Harbor:Social EM resources
- Harbor:Social work
- Harbor:Stimulant Use Disorder Treatment
- Harbor:Stress Testing
- Harbor:Substance Use Disorder
- Harbor:Surge plan
- Harbor:Teaching Rounds Topics
- Harbor:Transfer/Discharge to Specialty Clinic
- Harbor:Transfer to Comprehensive Stroke Center
- Harbor:Transfer to L&D
- Harbor:Transferring a patient
- Harbor:Transferring to psych ER
- Harbor:Transportation Needs
- Harbor:Trauma activations
- Harbor:Ultrasound approval list
- Harbor:Ultrasound reference card
- Harbor:Urgent Outpatient IR
- Harbor:Urgent Specialty Follow-up for DHS or MHLA Patients
- Harbor:VA MICU rotation
- Harbor:Wellness
- Harbor:Who goes to family medicine
- Harbor:Whole person care
- Harbor:XRT
- Harbor: Base Hospital Resource for Physicians and MICNs
- Harbor: Bullet Removal Guidelines
- Harbor: ED Bedside Ultrasound Policy and Procedure Guidelines
- Harbor: Hyperbaric Transfers
- Harbor: Identifying Jane/John Doe, finding next of kin tips
- Harbor: Macros and Autotext
- Harbor: Reporting to DCFS
- Harbor: Social Resources
- Harbor: Thoraco lumbar sacral orthosis
- HarborUCLA:5S
- HarborUCLA:Administrative resident
- HarborUCLA:EKG screening
- HarborUCLA:Main
- HarborUCLA:Pediatric ED (main)
- HarborUCLA:Receiving phone calls
- HarborUCLA:Triaging ambulance runs
- Harbor Macros: AMA
- Harbor Macros: Abdominal Pain
- Harbor Macros: Abdominal Pain(Female)
- Harbor Macros: Back Pain
- Harbor Macros: Chest Pain
- Harbor Macros: EKG
- Harbor Macros: Pediatrics
- Harbor Macros: Syncope
- Harbor UCLA - CIR