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''' 4/6/21
** '''DHS Visitor Policy''' 6/15/21
*** Must screen neg for COVID questions
https://lacounty.sharepoint.com/sites/DHS-COVID19/ExpectedPractices/Forms/Newest%20on%20Top.aspx?id=%2Fsites%2FDHS%2DCOVID19%2FExpectedPractices%2FDHS%20COVID%20Visitation%2Epdf&parent=%2Fsites%2FDHS%2DCOVID19%2FExpectedPractices
**** If Positive screen, ok if with PED or patient who needs assistance (but the visitor must be masked)
*** Signage posted at the entrances (no individual screening)
**** If positive screen, ok if 2 weeks post-vaccination
**** In the last 24 hours, have you had a temperature of ≥100.4 ̊F and/or thought you had a fever?
**** In the last 24 hours, have you had a cough, shortness of breath, difficulty breathing, chills, muscle or body aches, new loss of taste or smell?
**** If you have not been vaccinated against COVID-19, have you had any contact with someone who had a confirmed case of COVID-19/coronavirus in the past 14 days?
***** If Positive screen, ok if with PED or patient who needs assistance (but the visitor must be masked)
****** Parents who have recently been exposed to COVID-19 may still come into building if they have received and are two weeks beyond all required doses of the COVID-19 vaccination and can show proof of vaccination.
*** '''MUST wear a facility-provided face mask at all times while in the hospital'''
**** Patients who refuse to wear a mask will be required to remain outside of building until the time of appointment at which time only the patient (no visitors) will be directly escorted to the appointment site
**** Failure of a visitor to mask will result in being asked to immediately leave the hospital; must stay in the patient’s room for the entire visit except as noted below
*** '''2 visitors in the ED'''
*** '''2 visitors in the ED'''
**** Visitors may be required to wear appropriate PPE, per Nursing instructions based on isolation precautions.  In some circumstances,  visitors may only be able to view the patient from outside of the room.




Revision as of 19:23, 16 June 2021

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

Admin Updates


  • PACS downtime Thursday 6/17 5a-6a


  • COVID VACCINES AVAILABLE to ALL PATIENTS 16 and older with ORCHID MRN:
    • While in the ED
      • Provider will order the Janssen or Pfizer vaccine
      • RN will complete Ad Hoc COVID Vaccine powerform
      • Pharmacy will send the dose; RN to complete card and give pt info sheet (comes with the shot from pharmacy)
      • Clerk to schedule 2nd appt
        • appt type: PC Immunization COVID 19 New Nurse Walk-In
        • appt location: HAR Express
        • Confirm appt —> conversation: Immunization Prereg
  • Outpatient
    • Can be OOP or MHLA
    • Can schedule or patient can call or walk in
      • Patient can call Patient Access Center (PAC) x66500 to schedule
      • Have patient pick a time, then mark depart process needs appt. ED clerk can schedule and give them the appointment confirmation page
        • clerk selects:
          • appt type: PC Immunization COVID 19 New Nurse Walk-In
          • appt location: HAR Express
          • Confirm appt —> conversation: Immunization Prereg
    • Fridays either 8a-noon or 1p-4p


  • No CCC for specialty e-consult
    • DHS: message PCP for anything urgent
    • OOP: return to PCP
    • NOT EMPANELED DHS ELIGIBLE: NERF for PCP who can submit e-consult
    • CCC: still available for non-empaneled DHS eligible patients with urgent follow-up needs (eg., uncontrolled DM)
    • Goal: Reduce number of CCC referrals solely for e-consults to ZERO by September 2021


  • Interventional Radiology (IR) - outpatient (dialysis catheter, etc)
    • For DHS/MHLA patients who require an urgent IR procedure, and have no other indication to be admitted, then the patient will be accommodated in the IR schedule to get their procedure done within 24-48 hours as outpatient.
    • ED provider will discuss with the IR resident in call.
      • IR Business hours:
        • If request for outpatient urgent IR procedure happens during the hours that IR clerk is available, then the providers can discuss with IR if the procedure can be done the next day or day after.
        • The ED provider will need to fill out the grey IR paper form which will need to be delivered to IR in Room 40 (copies are in the hanging folders in doc boxes)
        • Patient will need CBC, chem 7, POC INR, and COVID test
      • Afterhours:
        • If request is approved by on call IR attending/resident, but the clerk is not there, then the plan should be to do the procedure not the next day, but the day after, to give time to create the appointment and FIN.
        • ED provider fills out grey form to be left under the door in room 40.
        • Patient will be contacted by the IR schedulers for exact appointment time and be told to go to OR second floor surgery registration area to get check in to be registered therefore do not need to come back to ED on the day of procedure.
      • For OOP patients:
        • ED providers can call UM to see if patient can be transferred to in-network hospital, or an urgent appointment with patient's PCP or specialist can be made. If patient's care cannot be safely transferred to in-network, then we can request for an authorization to admit the patient, given that procedure will be done the next day.


https://lacounty.sharepoint.com/sites/DHS-COVID19/ExpectedPractices/Forms/Newest%20on%20Top.aspx?id=%2Fsites%2FDHS%2DCOVID19%2FExpectedPractices%2FDHS%20COVID%20Visitation%2Epdf&parent=%2Fsites%2FDHS%2DCOVID19%2FExpectedPractices

      • Signage posted at the entrances (no individual screening)
        • In the last 24 hours, have you had a temperature of ≥100.4 ̊F and/or thought you had a fever?
        • In the last 24 hours, have you had a cough, shortness of breath, difficulty breathing, chills, muscle or body aches, new loss of taste or smell?
        • If you have not been vaccinated against COVID-19, have you had any contact with someone who had a confirmed case of COVID-19/coronavirus in the past 14 days?
          • If Positive screen, ok if with PED or patient who needs assistance (but the visitor must be masked)
            • Parents who have recently been exposed to COVID-19 may still come into building if they have received and are two weeks beyond all required doses of the COVID-19 vaccination and can show proof of vaccination.
      • MUST wear a facility-provided face mask at all times while in the hospital
        • Patients who refuse to wear a mask will be required to remain outside of building until the time of appointment at which time only the patient (no visitors) will be directly escorted to the appointment site
        • Failure of a visitor to mask will result in being asked to immediately leave the hospital; must stay in the patient’s room for the entire visit except as noted below
      • 2 visitors in the ED
        • Visitors may be required to wear appropriate PPE, per Nursing instructions based on isolation precautions. In some circumstances, visitors may only be able to view the patient from outside of the room.


  • 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)


  • HIPPABridge goes away 4/30; replace with TEAMS for text, picture, or video communication regarding patient care


  • Eye drops (vanco & tobra) and HIV prophylaxis (raltegravir and Truvada) for home - coming soon ~6/7/21
    • For patients needing glaucoma or corneal ulcer meds from pharmacy, there is a new process to order from pharmacy and allow the patient to legally take the meds home
      • Daytime Outpatient Pharmacy Hours (M-F 7a-10p, S/S 8a-6p):
        • 1 - Place typical order and in comments section write "ok to use home med in ED"
        • 2 - E-Rx as usual
        • Process:
          • RN to call outpatient pharmacy to notify med need immediately
          • Pharmacy calls RN when Rx and med info sheets are ready
          • USA picks up med in med box, gives to bedside RN
          • RN signs pickup slip and USA returns to pharmacy
      • After Outpatient Pharmacy Hours:
        • 1 - Place typical order for meds
        • 2 - E-Rx and add comment "dispensed by ED Pharmacist"


  • Reminder: Keep HL patients on track in AWR and HL Taskforce will DC once the patient has been seen and all SW issues addressed


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

Harbor ED policy manual

Harbor Legal

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.

Outpatient IR

  • Interventional Radiology (IR) - outpatient - for items such as stenosed/thrombosed dialysis catheter, etc
    • For DHS/MHLA patients who require an urgent IR procedure, and have no other indication to be admitted, then the patient will be accommodated in the IR schedule to get their procedure done within 24-48 hours as outpatient.
    • ED provider will discuss with the IR resident in call.
      • IR Business hours:
        • If request for outpatient urgent IR procedure happens during the hours that IR clerk is available, then the providers can discuss with IR if the procedure can be done the next day or day after.
        • The ED provider will need to fill out the grey IR paper form which will need to be delivered to IR in Room 40 (copies are in the hanging folders in doc boxes)
        • Patient will need CBC, chem 7, POC INR, and COVID test
      • Afterhours:
        • If request is approved by on call IR attending/resident, but the clerk is not there, then the plan should be to do the procedure not the next day, but the day after, to give time to create the appointment and FIN.
        • ED provider fills out grey form to be left under the door in room 40.
        • Patient will be contacted by the IR schedulers for exact appointment time and be told to go to OR second floor surgery registration area to get check in to be registered therefore do not need to come back to ED on the day of procedure.
      • For OOP patients:
        • ED providers can call UM to see if patient can be transferred to in-network hospital, or an urgent appointment with patient's PCP or specialist can be made. If patient's care cannot be safely transferred to in-network, then we can request for an authorization to admit the patient, given that procedure will be done the next day.

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

Whole person care

Sepsis core measures

Occupational Exposure

Sexual Assault/STI Exposure (SART)

Others

Scheduled dialysis patients in ED

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

DC with meds in ED

  • Eye drops (vanco & tobra) and STI prophylaxis for home - starting 6/7/21
    • For patients needing glaucoma or corneal ulcer meds from pharmacy, there is a new process to order from pharmacy and allow the patient to legally take the meds home
      • Daytime Outpatient Pharmacy Hours (M-F 7a-10p, S/S 8a-6p):
        • 1 - Place typical order and in comments section write "ok to use home med in ED"
        • 2 - E-Rx as usual
        • Process:
          • RN to call outpatient pharmacy to notify med need immediately
          • Pharmacy calls RN when Rx and med info sheets are ready
          • USA picks up med in med box, gives to bedside RN
          • RN signs pickup slip and USA returns to pharmacy
      • After Outpatient Pharmacy Hours:
        • 1 - Place typical order for meds
        • 2 - E-Rx and add comment "dispensed by ED Pharmacist"


  • 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 in
  3. If either of above options is not possible, may 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 disorder (SUD)
      • Available SUD counselor in person Mon 8a-5p, T-F 8a-12:30a, Sat 4p-12:30a.
      • 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 Rosario Aliviado - Social Work Supervisor. Please include MRN, pt phone number, and reason for referral. (213) 294-8908. 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 Whole Person Care". Reason for Consult Freetext: "Substance Use" or "MAT" and any relevant details.
  • 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 (Mon-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 Program (844) 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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