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==
* Frequently used resources
** [[Harbor:Admission_and_consultation_guidelines|Admission Guidelines]]
** [[Harbor:ED_follow-up_options|Discharging to Clinics]]
*** [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]
*** [https://lacounty.sharepoint.com/:w:/t/EDOperations-HUCLA/ES3s8sXJdKBLpukbDXsHZfoBwhQCS17ogqrR8mC2TVNvcQ?e=xp82nc Ortho Consult Criteria]
** [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]]


* '''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]]
OLD TOPICS
* '''ED Request for Specialty Appointment''' order is live 7/25/2023!  No more black star in the depart menu. 
** [https://lacounty.sharepoint.com/:w:/s/medicineoutpatientspecialtycare/ESLCad7IJDxCjklxFLNfWwIB1hRf_HGr2t2n8u6MvqNHfw?e=4%3AFvJCKk&fromShare=true Referral Guidance Summary Sheet]
** [[Harbor:ED_follow-up_options|Details for Specific Clinics ]]
** How to Make an Appointment:  [[:File:ED Request for Specialty Appointment Hot Sheet 7-25-2023.pdf]]
 
* Happy July 4th:  [[Harbor:Replantation_Patients|Hand Replant Transfers to LAG]]
 
* [[Harbor:ED_follow-up_options#ORTHO|Ortho Follow-up Guidelines (5-2023)]]


* '''QR Code Resources'''
* '''QR Code Resources'''
** [[Harbor:QR_for_Staff|For Staff (QI forms and equipment issue links)]]
** [[Harbor:QR_for_Staff|For Staff (Equipment, EMS, Med Student Evals)]]
** [[Harbor:QR_for_Patients|For Patients]]
** [[Harbor:QR_for_Patients|For Patients]]
* 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]]
* '''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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**[[Harbor:EKG screening|EKG Screening]]
**[[Harbor:EKG screening|EKG Screening]]
**[[Harbor:5S|Pre-shift: 5S]]
**[[Harbor:5S|Pre-shift: 5S]]
**Airway Bag [[https://www.wikem.org/wiki/Harbor:Airway_management_team| Airway management team]]
**Airway Bag [[Harbor:Airway_management_team]]


===Administrative resources===
===Administrative resources===
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**[[Harbor:Direct Admission after Hours]]
**[[Harbor:Direct Admission after Hours]]
**[[Harbor:Core Measures|Core Measures]]
**[[Harbor:Core Measures|Core Measures]]
**[[Harbor:Crown Checks in PED|Crown Checks in PED]]


===[[Harbor:ED policy manual|Harbor ED policy manual]]===
===[[Harbor:ED policy manual|Harbor ED policy manual]]===
**[[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]]===


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===Radiology===
===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]]
Line 62: Line 146:
**[[Harbor:Ordering a CT|Ordering a CT]]
**[[Harbor:Ordering a CT|Ordering a CT]]
**[[Harbor:ED Radiology Specs|CT Specs]]
**[[Harbor:ED Radiology Specs|CT Specs]]
*[[Oral contrast]]
 
* Contrast Extravasation:
====Contrast====
* [[Creatinine_screening_prior_to_IV_contrast|IV Contrast]]
** [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]
** [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]
 
* [[Oral contrast for abdominal and pelvic CT|Oral Contrast]]
====[[Radiology Hours]]====
[[https://wikem.org/wiki/Harbor:Radiology_directory#Radiology_Directory| Radiology Directory]]


==== [[Urgent Outpatient IR]] ====
==== [[Urgent Outpatient IR]] ====
Line 96: Line 179:
*[[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===
Line 109: Line 192:
*[[Harbor:Code STEMI|STEMI Activation]]
*[[Harbor:Code STEMI|STEMI Activation]]
*[[Harbor:Trauma activations|Trauma Activations]]
*[[Harbor:Trauma activations|Trauma Activations]]
===[[Harbor:PE Response Team|PE Response Team]]===


===[[Harbor:Social work|Social Work]]===
===[[Harbor:Social work|Social Work]]===
Line 114: Line 198:
===[[Harbor:Alcohol Use Disorder/Withdrawal Treatment]]===
===[[Harbor:Alcohol Use Disorder/Withdrawal Treatment]]===
===[[Harbor:Stimulant Use Disorder Treatment]]===
===[[Harbor:Stimulant Use Disorder Treatment]]===
===[[Harbor:Baby Safe Surrender Program|Baby Safe Surrender Program]]===
===[[Harbor:Baby Safe Surrender Program|Baby Safe Surrender Program]]===
===[[Harbor: Reporting to DCFS|Reporting to DCFS]]===
===[[Harbor:Placement patients|'''Placement patients''']]===


California has a Safely Surrendered Baby Law, which gives parents or guardians the choice to legally and safely surrender their baby at any hospital or fire station in Los Angeles County, no questions asked. The parent or guardian may surrender the baby without fear of arrest or prosecution for child abandonment. Since the program was launched in LA County, over 180 newborns have been safely surrendered.
===[[Harbor: Identifying Jane/John Doe, finding next of kin tips]]===


[https://lacounty.gov/residents/family-services/child-safety/safe-surrender/ Find more information about the LA County Baby Safe Surrender Program Here]
===[[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]]===


'''If a parent/guardian surrenders an infant (less than 72 hours old) to Harbor UCLA, follow the below procedure:'''
1. Ask if they are the parent or guardian of the baby.
2. You may offer medical evaluation and emotional support services for the parent or guardian, however they can remain anonymous and simply drop the baby off.
3. The guardian should receive an I.D. bracelet that matches one that will be fastened to the baby’s ankle. The bracelet will help them get the baby back if they change their mind (they have 14 days from the day of surrender). They should also receive the informational brochure regarding next steps and a voluntary medical history form. The medical history form can be mailed in at a later date (stamp enclosed). These items can be found ????
4. Ensure the infant gets a medical exam in the pediatric emergency department.
5. Consult social work for DCFS involvement so that the baby may be placed in a safe environment per Safe Surrender Protocol
===[[Harbor:Placement patients|Placement patients]]===
===[[Harbor:PE Response Team|PE Response Team]]===
===[[Harbor:Psych patients|Psych Patients (Exodus)]]===
===[[Harbor: Identifying Jane/John Doe, finding next of kin tips]]===
===[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]===


===Sepsis===
===Sepsis===
Line 155: Line 221:
*[[Harbor:Infectious_Disease_Threats#Coronavirus_.28COVID-19.29|'''COVID''']]
*[[Harbor:Infectious_Disease_Threats#Coronavirus_.28COVID-19.29|'''COVID''']]
*[[Harbor:Ebola|Suspected Ebola protocol]]
*[[Harbor:Ebola|Suspected Ebola protocol]]
 
*[[Harbor:Infectious_Disease_Threats#Monkeypox\Monkeypox]]
===[https://wikem.org/wiki/Harbor:Transferring_a_patient| Transferring_a_patient]===
*[[Harbor:Exodus|Exodus Psych transfers]]
*[https://wikem.org/wiki/Harbor:Transferring_to_psych_ER| Transferring_to_psych_ER]


==Patient Disposition==
==Patient Disposition==
Line 208: Line 271:
===[[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:Exodus|Exodus Psych transfers]]
*[[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:XRT|XRT transfers]]
*[[Harbor:_Hyperbaric_Transfers|Harbor: Hyperbaric Transfers]]


==Documentation==
==Documentation==
Line 221: Line 292:
*[[Harbor:Disaster plan|Disaster plan]]
*[[Harbor:Disaster plan|Disaster plan]]
*'''[[Harbor:Surge plan|Surge plan]]'''
*'''[[Harbor:Surge plan|Surge plan]]'''
*[[Harbor:Diversion for ALS and BLS]]
*[[Harbor:ORCHID Downtime|ORCHID Downtime]]
*[[Harbor:ORCHID Downtime|ORCHID Downtime]]
*[[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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