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.''
==Admin Updates==
==Admin Updates==
* '''No CCC for specialty e-consult'''
* Frequently used resources
** DHS: message PCP for anything urgent
** [[Harbor:Admission_and_consultation_guidelines|Admission Guidelines]]
** OOP: return to PCP
** [[Harbor:ED_follow-up_options|Discharging to Clinics]]
** '''NOT EMPANELED DHS ELIGIBLE''': NERF for PCP who can submit e-consult
*** [https://lacounty.sharepoint.com/:w:/s/medicineoutpatientspecialtycare/ESLCad7IJDxCjklxFLNfWwIB1hRf_HGr2t2n8u6MvqNHfw?e=4%3AFvJCKk&fromShare=true ED to Specialty Clinic DC - please check instructions for each specific clinic prior to making an appointment]
** CCC: still available for non-empaneled DHS eligible patients with urgent follow-up needs (eg., uncontrolled DM)
*** [https://lacounty.sharepoint.com/:w:/t/EDOperations-HUCLA/ES3s8sXJdKBLpukbDXsHZfoBwhQCS17ogqrR8mC2TVNvcQ?e=xp82nc Ortho Consult Criteria]
** Goal:  Reduce number of CCC referrals solely for e-consults to ZERO by September 2021
** [https://wikem.org/wiki/Harbor:Expedited_Work-up_Clinic_(EWC) Expedited Workup Clinic]
** [https://wikem.org/wiki/Harbor:Placement_patients Placement Patients]
** [[Harbor:STAT_MRI|Ordering a MRI]]
** [https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis Breast Abscess]
** [https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Breast_mass.2Fmalignancy Breast Mass]
** [https://wikem.org/wiki/Harbor:ED_follow-up_options#ORTHO Ortho:  Splint vs Consult]
** [https://wikem.org/wiki/Harbor:Psych_patients Psych:  OSA, Covid, & Exodus]
** [https://wikem.org/wiki/Harbor:Infectious_Disease_Threats#Treatment Covid Treatment Options]
** [https://wikem.org/wiki/Harbor:QR_for_Staff QR Code:  Equipment issues, Prehospital problems, Med Student evals, Resident Shout-outs]
** [[Harbor:Surge_plan|Surge Criteria/Plan]]




* '''COVID VACCINES AVAILABLE to ALL PATIENTS 16 and older with ORCHID MRN''':  
OLD TOPICS
** Can schedule for, patient can call or walk in
* '''ED Request for Specialty Appointment''' order is live 7/25/2023! No more black star in the depart menu.
***Have patient pick a time, then mark depart process needs appt. ED clerk can schedule and give them the appointment confirmation page
** [https://lacounty.sharepoint.com/:w:/s/medicineoutpatientspecialtycare/ESLCad7IJDxCjklxFLNfWwIB1hRf_HGr2t2n8u6MvqNHfw?e=4%3AFvJCKk&fromShare=true Referral Guidance Summary Sheet]
**** clerk selects:
** [[Harbor:ED_follow-up_options|Details for Specific Clinics ]]
***** appt type: PC Immunization COVID 19 New Nurse Walk-In
** How to Make an Appointment:  [[:File:ED Request for Specialty Appointment Hot Sheet 7-25-2023.pdf]]
***** appt location:  HAR Express
***** Confirm appt —> conversation: Immunization Prereg
** Tues & Fri 8a-4p (lunch break 12-1p)
** Patient can call Patient Access Center (PAC) x66500 to schedule
** Can be OOP or MHLA


* [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
* Happy July 4th:  [[Harbor:Replantation_Patients|Hand Replant Transfers to LAG]]
** '''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
* [[Harbor:ED_follow-up_options#ORTHO|Ortho Follow-up Guidelines (5-2023)]]
** '''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
* '''QR Code Resources'''
** [[Harbor:QR_for_Staff|For Staff (Equipment, EMS, Med Student Evals)]]
** [[Harbor:QR_for_Patients|For Patients]]


*[https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines|Updated Admission and Consultation Guidelines - May 2020]
* Hyperbaric treatment for CO
** Options - UCLA Westwood, Long Beach Memorial, UCSD,  '''NOT MAC to Catalina''' (only for dive injuries)
** UR coordinates the acceptance
** Transfers:  UR should help coordinate the transfer - ELTC/HLOC - needs to occur <1-2 hrs
*** Sending facility is supposed to arrange transfer
*** If UR not able to get transfer in a timely manner --> MAC (CDO) - must be approved by house supervisor & Joy; BLS/ALS/CC transport
**** Medics can call the radio for online base medical direction/orders
 
 
*New Expedited Work up Clinic referral process: https://www.wikem.org/wiki/Harbor:Expedited_Work-up_Clinic_(EWC)
*New asthma guidelines
**The preferred DHS controller medication is Symbicort (formeterol – long-acting B-agonist + budesonide – inhaled corticosteroid), 2nd line is Advair (salmeterol + fluticasone). 
**If seeing the patient in the ED for an asthma exacerbation, please be sure to refill their controller medication AND the albuterol (if needed).  We fall out if they fill more albuterol Rx’s in a year than their controller medication, so we need to make sure they get both when seen in the ED.  If prescribing albuterol, do not give refills (you get 200 puffs!).
*Sepsis – remember to do the required components of the sepsis core measure w/in 3 hrs (30ml/kg, bcx, abx), document using the auto text (use “auto text copy utility” to get Brad Chappell’s “ .harsepsis” to go through the reminder guidance text and exclusions for IVF 30ml/kg. Communicate to the admitting team if they need to repeat the lactate and perform the sepsis reassessment exam with time stamp (w/in 6 hrs). 
*If UR is suggesting a transfer to Rancho Los Amigos (RLA), then place the ‘consult to Transfer Center’ order. The Transfer Center is a county entity that helps transfer patients between county facilities. 
 
*Synapse got a new look. See link for details. A [https://lacounty.sharepoint.com/:b:/s/dhs-eci/ESN8ppJYxPZGhUcV9ZGyWYMB8do8sVnRqmBWuNyKG5x-7A?e=RpdAsg one-page intro guide] are available on [https://lacounty.sharepoint.com/sites/dhs-eci/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2Fdhs%2Deci%2FShared%20Documents%2FRadiology%2FPACS%205%2E7%20Upgrade%2FGuides%2FQuick%20Start%20Tutorial&p=true&originalPath=aHR0cHM6Ly9sYWNvdW50eS5zaGFyZXBvaW DHS SharePoint]
**Alt+C still works to compare studies.
**Open the PowerJacket (folder icons) and then you can pull up the read on 'reports'. Click the dropdown to switch from 'report' to 'notes' to find a free text prelim read.
**Change your default settings to what PowerJacket looks like and select ‘Notes’ and ‘Reports’ to always open so you can see prelim and final reads, respectively.
*Patient Relations Representatives (PRR) 3p-2a, 7days a week – call Registration for PRR who can help empanel into DHS or change empanelment/network in real time in the ED. PRR can come to bedside to meet with patient or send patient to Registration Windows. During business hours, send patient to Patient Relations Office in Rm 1-B-1.
 
* '''Harbor's COVID page''' [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
** Paxlovid, Remdesivir, etc ... [[Harbor:Infectious_Disease_Threats#Treatment|COVID Treatment Options]]
 
* '''Interqual criteria''' [[Harbor:Interqual_Criteria_Tips|Interqual Criteria Tips]]
 
* '''Monkeypox'''
** See [[Monkeypox]] for medical information  &  [[Harbor:Infectious_Disease_Threats#Monkeypox|Harbor Monkeypox Plan]]
** Educational Material
*** [http://publichealth.lacounty.gov/acd/Monkeypox.htm LA County Monkeypox]
*** [http://publichealth.lacounty.gov/media/monkeypox/docs/Monkeypox_IntimateContact.pdf LAC DPH Monkeypox]
*** http://publichealth.lacounty.gov/media/monkeypox/resources.htm#reduce
*** [https://www.cdc.gov/poxvirus/monkeypox/resources/print.html CDC Monkeypox]
 
 
* '''Active Threat in the ED'''
** Situational awareness
*** Stand between door and patient
*** Ensure patient is gowned
*** Be aware of long stethoscope, lanyard, long hair, etc
*** Panic buttons at nursing stations/router
*** Run & scream for help
** Hospital Codes
*** Gold x111 - combative/agitated patient
*** Gray x64450 - combative/agitated NON-patient
*** Silver x111 - weapon, active shooter, hostage


==General Administrative==
==General Administrative==
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***Exodus should call Psych ED about transfer, not Med ED
***Exodus should call Psych ED about transfer, not Med ED
***Med ED will do MSE
***Med ED will do MSE
===[[Harbor:Screening EMS Patients|Screening EMS Patients]]===
*DEM AOD [[Harbor:DEM_Admin_on_Duty_(AOD)|DEM Admin on Duty (AOD)]]
* [[Harbor:Resident responsibilities and transitions of responsibility|Resident Responsibilities]]
 
===[[Harbor:Screening EMS Patients|Ambulance (EMS) Triage]]===
 
===Administrative duties===
===Administrative duties===
**[[Harbor:Administrative resident|Administrative resident directions]]
**[[Harbor:Administrative resident|Administrative resident directions]]
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**[[Harbor:EKG screening|EKG Screening]]
**[[Harbor:EKG screening|EKG Screening]]
**[[Harbor:5S|Pre-shift: 5S]]
**[[Harbor:5S|Pre-shift: 5S]]
**Airway Bag
**Airway Bag [[Harbor:Airway_management_team]]
***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===
===Administrative resources===
===[[Harbor:RME & TRIAGE|RME & triage]]===
===[[Harbor:RME & TRIAGE|RME & triage]]===
**[[Harbor:Direct Admission after Hours]]
**[[Harbor:Direct Admission after Hours]]
**[[Harbor:Core Measures|Core Measures]]
**[[Harbor:Core Measures|Core Measures]]
**[[Harbor:ED policy manual|Harbor ED policy manual]]
**[[Harbor:Crown Checks in PED|Crown Checks in PED]]
**[[Harbor:ED attending on call plan|ED attending on call plan]]
 
**[[Harbor:Legal|Harbor Legal]]
===[[Harbor:ED policy manual|Harbor ED policy manual]]===
**[[Harbor:Ophtho abbreviation dictionary]]
===[[Harbor:ED attending on call plan|ED attending on call plan]]===
 
===[[Harbor:Legal|Harbor Legal]]===


==Managing your Patient==
==Managing your Patient==
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====[[Harbor:Paging|Paging consultants]]====
====[[Harbor:Paging|Paging consultants]]====
*[[Harbor:Ophtho abbreviation dictionary]]
====[[Harbor:Phone numbers|Phone numbers]]====
====[[Harbor:Phone numbers|Phone numbers]]====
====[[Harbor:Radiology directory|Radiology directory]]====
====[[Harbor:Radiology directory|Radiology directory]]====
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===Tests & Orders===
===Tests & Orders===
*[[Harbor:Labs|Labs]]
*[[Harbor:Labs|Labs]]
====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


====[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]====
 
===Radiology===
====[[Radiology Hours]]====
[[https://wikem.org/wiki/Harbor:Radiology_directory#Radiology_Directory| Radiology Directory]]
 
====US & QPathE====
* [https://dhsqpath.qpath.cloud '''QPathE Login link''']
** Login using e# and associated password
** Double-click the exam
** Click "edit" at the top of the page
** Enter MRN in the "patient ID" box
** in "comments" enter trauma FAST
** Click save at top of screen
 
 
*Ultrasound
*Ultrasound
**[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal 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]]
**[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
**Cleaning Endocavitary Probes
**[[Endocavitary Probes]]
***Place in Red Bag (above probe cabinet in clean utility room)
*[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]
***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]]
*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
*CT
*CT
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**[[Harbor:ED Radiology Specs|CT Specs]]
**[[Harbor:ED Radiology Specs|CT Specs]]


*Oral contrast
====Contrast====
**No more gastrograffin, replaced by omnipaque. Must place an order for it. If you need to obtain a retrograde urethrogram, order a KUB.
* [[Creatinine_screening_prior_to_IV_contrast|IV Contrast]]
**Below is the suggested/usual volume of omnipaque used for certain indication sent to us by Dr. Putnam:
** [https://lacounty.sharepoint.com/sites/dhs-harbor-pharm/PrePrinted%20Forms/Forms/AllItems.aspx?id=%2Fsites%2Fdhs%2Dharbor%2Dpharm%2FPrePrinted%20Forms%2FExtravasation%20Management%20Provider%20Order%20Form%20P294%20%2810%2E6%2E20%29%2Epdf&parent=%2Fsites%2Fdhs%2Dharbor%2Dpharm%2FPrePrinted%20Forms| Hyaluronidase for IV Contrast Extravasation order Form]
***For use in bowel obstruction, a volume of 100cc of Omnipaque 300 is used.
* [[Oral contrast for abdominal and pelvic CT|Oral Contrast]]
***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.


==== [[Urgent Outpatient IR]] ====


====[[Harbor:STAT MRI|STAT MRI]]====
====[[Harbor:STAT MRI|STAT MRI]]====
*[[Harbor:ED Radiology Specs|MRI Specs]]
*[[Harbor:ED Radiology Specs|MRI Specs]]
*Other orders
**[[Harbor:Ordering Blood Products|Blood products]]
**Antibiotics


====[[Harbor:Antibiogram|Antibiogram]]====
====Upload Outside Films to PACS====
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
***[[Harbor:Sepsis core measures|Sepsis core measures]]
*Buprenorphine/Opiate Withdrawal Treatment
**[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
 
==== Upload Outside Films to PACS====
*Get form from clerk
*Get form from clerk
*Put patient sticker on Form
*Put patient sticker on Form
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**Check "Export"
**Check "Export"
**Write time frame on form you want studies from
**Write time frame on form you want studies from
===[[Harbor:Ordering Blood Products|Blood products]]===
===[[Harbor:Antibiogram|Antibiogram]]===
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
***[[Harbor:Sepsis core measures|Sepsis core measures]]


===Finding Equipment/DME===
===Finding Equipment/DME===
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*[[Harbor:DME|Durable Medical Equipment (DME)]]
*[[Harbor:DME|Durable Medical Equipment (DME)]]


====[[Harbor:ED supplies A-Z|E supplies A-Z]]====
====[[Harbor:ED supplies A-Z|ED supplies A-Z]]====


===Procedures===
===Procedures===
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==Special patient types==
==Special patient types==
*[[Harbor:Whole person care|Whole person care]]
===[[Harbor:Codes|Code Activations]]===
*[[Harbor:Social work|Social work]]
*[[Harbor:Involuntary holds|Involuntary Holds]]
*Activations
*[[Harbor:Airway management team|Airway Management Team]]
**[[Harbor:Codes|Code Activations]]
*[[Harbor:Code stroke|Code Stroke]]
***[[Harbor:Involuntary holds|Involuntary holds]]
*[[Harbor:Code STEMI|STEMI Activation]]
**[[Harbor:Airway management team|Airway management team]]
*[[Harbor:Trauma activations|Trauma Activations]]
**[[Harbor:Code stroke|Code Stroke]]
===[[Harbor:PE Response Team|PE Response Team]]===
**[[Harbor:Code STEMI|STEMI Activation]]
 
**[[Harbor:Trauma activations|Trauma Activations]]
===[[Harbor:Social work|Social Work]]===
*Sepsis
===[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]===
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
===[[Harbor:Alcohol Use Disorder/Withdrawal Treatment]]===
**[[Harbor:Sepsis core measures|Sepsis core measures]]
===[[Harbor:Stimulant Use Disorder Treatment]]===
*'''[[Harbor:Occupational exposure|Occupational Exposure]]'''
===[[Harbor:Baby Safe Surrender Program|Baby Safe Surrender Program]]===
===[[Harbor: Reporting to DCFS|Reporting to DCFS]]===
===[[Harbor:Placement patients|'''Placement patients''']]===
 
===[[Harbor: Identifying Jane/John Doe, finding next of kin tips]]===
 
===[[Harbor:Psych patients|Psych Patients (& Exodus)]]===
 
===[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]===
 
===[[Harbor:NFL Injured Player/Staff Protocol|NFL Injured Player/Staff Protocol]]===
 
 
===Sepsis===
*[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
===[[Harbor:Sepsis core measures|Sepsis core measures]]===
==='''[[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 (SART)]]'''===
*[[Harbor:PE Response Team|PE Response Team]]
 
*[[Harbor:Psych patients|Psych Patients (Exodus)]]
===[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]===
*[[Harbor: Identifying Jane/John Doe, finding next of kin tips]]
*[[Harbor:Infectious_Disease_Threats#Coronavirus_.28COVID-19.29|'''COVID''']]
===Others===
*[[Harbor:Ebola|Suspected Ebola protocol]]
*[[Harbor:AVF/graft complications|AVF/graft complications]]
*[[Harbor:Infectious_Disease_Threats#Monkeypox\Monkeypox]]
*[[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==
===Discharge===
===Discharge===
====[[Harbor: ED Follow-Up Options|'''ED Follow-Up Options''']]====
*[[Harbor:Prescribing|Prescribing]]
*[[Harbor:Prescribing|Prescribing]]
*[[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]
====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.


===='''[[Harbor: ED Follow-Up Options|ED Follow-Up Clinics]]'''====
====[[DC with meds in ED]]====
*'''[[Harbor:Forms|Forms]]'''
* Eye drops (vanco & tobra) and STI prophylaxis for home
* HIV prophylaxis for sexual assault patients (raltegravir and Truvada)
 
 


*Follow-up of out patient labs/imaging
*'''[[Harbor:Forms| Paper Forms]]'''
**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:Coumadin clinic|Coumadin clinic]]
*[[Harbor:Coumadin clinic|Coumadin clinic]]
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*[[Harbor:Home hospice from ED]]
*[[Harbor:Home hospice from ED]]


===Transportation Needs===
====[[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:
====[[Social EM resources]]====
**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===
*[https://www.wikem.org/wiki/Harbor:Social_work 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
*[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
*[[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]]
*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===
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*[[Harbor:Admitting a patient|Admitting a patient]]
*[[Harbor:Admitting a patient|Admitting a patient]]
*[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
*[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
====[[Harbor:Interqual Criteria Tips|Interqual Criteria Tips]]====
====[[Harbor:Interqual Override Notes|Interqual Override Notes]]====
====[[Harbor:Interqual Override Notes|Interqual Override Notes]]====


====[[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]]
*Admitting to Medicine - use MS Teams (no more clipboard)
*[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]]
*[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]]
*[[Harbor:Direct Admission after Hours|Direct Admission after Hours]]
*[[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]]===
===[[Harbor:Scheduled_dialysis_patients_in_ED|Dialysis in the ED]]===
Line 282: Line 269:
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
* [[Harbor:Deceased patients|Deceased patients]]
* [[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:Exodus|Exodus Psych transfers]]
**[[Harbor:Replantation Patients|Replantation patient transfer]]
*[[Harbor:Transfer to L&D|Transfer to L&D]]
*[[Harbor:Transfer/Discharge to Specialty Clinic|Transfer/Discharge to Specialty Clinic]]
*[[Harbor:911 STEMI out|911 STEMI out]]
*[[Harbor:MAC Transfer Burn or Replant|MAC Transfer Burn or Replant]]
*[[Harbor:Replantation_Patients|Hand Replant]]
*[[Harbor:Transfer to Comprehensive Stroke Center|Transfer to Comprehensive Stroke Center]]
*[[Harbor:XRT|XRT transfers]]
*[[Harbor:_Hyperbaric_Transfers|Harbor: Hyperbaric Transfers]]


==Documentation==
==Documentation==
Line 301: Line 295:
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
**[[Harbor:Ebola|Suspected Ebola protocol]]
**[[Harbor:Ebola|Suspected Ebola protocol]]
* Environmental Exposure:
** Ask Hazmat Response team or Incident Commander what decon has occurred on scene
** [https://www.atsdr.cdc.gov/toxprofiledocs/index.html CDC Tox Profile Lookup]


==Resident Education==
==Resident Education==

Latest revision as of 21:15, 11 April 2024

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

Admin Updates


OLD TOPICS

  • Hyperbaric treatment for CO
    • Options - UCLA Westwood, Long Beach Memorial, UCSD, NOT MAC to Catalina (only for dive injuries)
    • UR coordinates the acceptance
    • Transfers: UR should help coordinate the transfer - ELTC/HLOC - needs to occur <1-2 hrs
      • Sending facility is supposed to arrange transfer
      • If UR not able to get transfer in a timely manner --> MAC (CDO) - must be approved by house supervisor & Joy; BLS/ALS/CC transport
        • Medics can call the radio for online base medical direction/orders


  • New Expedited Work up Clinic referral process: https://www.wikem.org/wiki/Harbor:Expedited_Work-up_Clinic_(EWC)
  • New asthma guidelines
    • The preferred DHS controller medication is Symbicort (formeterol – long-acting B-agonist + budesonide – inhaled corticosteroid), 2nd line is Advair (salmeterol + fluticasone).
    • If seeing the patient in the ED for an asthma exacerbation, please be sure to refill their controller medication AND the albuterol (if needed). We fall out if they fill more albuterol Rx’s in a year than their controller medication, so we need to make sure they get both when seen in the ED. If prescribing albuterol, do not give refills (you get 200 puffs!).
  • Sepsis – remember to do the required components of the sepsis core measure w/in 3 hrs (30ml/kg, bcx, abx), document using the auto text (use “auto text copy utility” to get Brad Chappell’s “ .harsepsis” to go through the reminder guidance text and exclusions for IVF 30ml/kg. Communicate to the admitting team if they need to repeat the lactate and perform the sepsis reassessment exam with time stamp (w/in 6 hrs).
  • If UR is suggesting a transfer to Rancho Los Amigos (RLA), then place the ‘consult to Transfer Center’ order. The Transfer Center is a county entity that helps transfer patients between county facilities.
  • Synapse got a new look. See link for details. A one-page intro guide are available on DHS SharePoint
    • Alt+C still works to compare studies.
    • Open the PowerJacket (folder icons) and then you can pull up the read on 'reports'. Click the dropdown to switch from 'report' to 'notes' to find a free text prelim read.
    • Change your default settings to what PowerJacket looks like and select ‘Notes’ and ‘Reports’ to always open so you can see prelim and final reads, respectively.
  • Patient Relations Representatives (PRR) 3p-2a, 7days a week – call Registration for PRR who can help empanel into DHS or change empanelment/network in real time in the ED. PRR can come to bedside to meet with patient or send patient to Registration Windows. During business hours, send patient to Patient Relations Office in Rm 1-B-1.


  • Active Threat in the ED
    • Situational awareness
      • Stand between door and patient
      • Ensure patient is gowned
      • Be aware of long stethoscope, lanyard, long hair, etc
      • Panic buttons at nursing stations/router
      • Run & scream for help
    • Hospital Codes
      • Gold x111 - combative/agitated patient
      • Gray x64450 - combative/agitated NON-patient
      • Silver x111 - weapon, active shooter, hostage

General Administrative

Ambulance (EMS) Triage

Administrative duties

Administrative resources

RME & triage

Harbor ED policy manual

ED attending on call plan

Harbor Legal

Managing your Patient

General

On shift (PC) Cheat Sheet

Paging consultants

Phone numbers

Radiology directory

Tests & Orders


Radiology

Radiology Hours

[Radiology Directory]

US & QPathE

  • QPathE Login link
    • Login using e# and associated password
    • Double-click the exam
    • Click "edit" at the top of the page
    • Enter MRN in the "patient ID" box
    • in "comments" enter trauma FAST
    • Click save at top of screen


Contrast

Urgent Outpatient IR

STAT MRI

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

Blood products

Antibiogram

Finding Equipment/DME

ED supplies A-Z

Procedures

Special patient types

Code Activations

PE Response Team

Social Work

Opiate Withdrawal/MAT/BUP

Harbor:Alcohol Use Disorder/Withdrawal Treatment

Harbor:Stimulant Use Disorder Treatment

Baby Safe Surrender Program

Reporting to DCFS

Placement patients

Harbor: Identifying Jane/John Doe, finding next of kin tips

Psych Patients (& Exodus)

Scheduled dialysis patients in ED

NFL Injured Player/Staff Protocol

Sepsis

Sepsis core measures

Occupational Exposure

Sexual Assault/STI Exposure (SART)

Infectious Disease Threats

Patient Disposition

Discharge

ED Follow-Up Options

DC with meds in ED

  • Eye drops (vanco & tobra) and STI prophylaxis for home
  • HIV prophylaxis for sexual assault patients (raltegravir and Truvada)


Transportation Needs

Social EM resources

Admission

Admission Guidelines

Interqual Criteria Tips

Interqual Override Notes

Right level of care

OBS & CORE


Dialysis in the ED

Other Disposition

Transferring a patient

Documentation

Disaster & Surge

Resident Education

See Also

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