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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.''
==Message of the Moment==
+
==Admin Updates==
Check here for the latest in ED administrative news!
+
* [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
 +
** Visitor Policy:
 +
*** End of life:  1 visitor at a time, 2 visitors per day, up to 4 hours total
 +
*** ALOC/disruptive behavior: 1 visitor at discretion of clinical team
 +
*** ICU: 1 per day, 2 hours max
 +
*** Peds:  1 visitor/guardian
 +
*** Consult IPC if visitor has COVID or COVID exposure
 +
* New Flu diagnosis and treatment algorithm for 2020-21 [[:File:Flu Dx and Tx algorithm 2020-21 V.2 final.pdf]]
  
==[[Harbor: Administrative Resident Role|General Administrative]]==
+
*Transitional Dialysis in the ED/5W,Room10: [[Harbor:Scheduled_dialysis_patients_in_ED]] Starting Wednesday, 7/8/2020
*[[Harbor:Administrative resident|Administrative resident directions]]
 
*[[Harbor: Phone Calls|Receiving Phone Calls]]
 
**[[Harbor:Critical Result Callback]]
 
*[[Harbor: Triaging Ambulance Runs|Triaging Ambulance Runs]]
 
*[[Harbor:EKG screening|EKG Screening]]
 
*[[Harbor:5S|Pre-shift: 5S]]
 
*[[Harbor:Legal]]
 
  
==Managing your Patient==
+
*OBS Update (6/2/2020) - for patients being admitted to the new '''short-stay medicine team, page the ED hospitalist at 204-9753, order "PLACE IN OBS" (just like we did pre-COVID)'''; the medicine team will order the "request for admit" once they get the COVID test results.  Drs. Spiegel & Chappell
===Ordering===
 
*[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
 
*[[Harbor:Ultrasound Approval List|Ultrasound approval list]]
 
*[[Harbor:Ordering a CT|Ordering a CT]]
 
*[[Harbor:Ordering Blood Products|Ordering Blood Products]]
 
*Ordering antibiotics
 
**[[Harbor:Antibiogram|Harbor antibiogram]]
 
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
 
***[[Harbor:Sepsis core measures|Sepsis core measures]]
 
  
===Documenting===
+
*[https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines|Updated Admission and Consultation Guidelines - May 2020]
*[[Harbor:Attending documentation|Attending documentation]]
 
*[[Harbor: Consenting a Patient|Consenting a Patient]]
 
*[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]
 
*[[Harbor: Macros and Autotext]]
 
  
===Procedures===
+
* iSTAT:  as of Sunday 1/26/20, the blue cartridges will be pulled from the floors (Chem 8 & CG4 - lactate, pH, CO2, pO2, HCO3, base excess)
*[[Harbor:Equipment|Equipment]]
+
** please use the EC7 as needed (Na, K, iCa, H/H, pH, CO2, pO2, HCO3, base excess)
*[[Harbor:Consenting a patient|Consenting a patient]]
+
** You will have to wait for serum lactate from lab
 +
** https://www.pointofcare.abbott/shared/static-assets/other/APOC2020-001%20CHEM8+%20CG4+%20capillary%20and%20CLIA%20notification%20letter%20FINAL.pdf
  
===Finding Things===
+
==General Administrative==
*[[Harbor:Forms|Forms]]
+
*Pre-hospital
*[[Harbor:Paging|Paging consults]]
+
**[[Harbor:Incoming transfers|Incoming transfers]]
 +
**Exodus Transfers
 +
***Exodus should call Psych ED about transfer, not Med ED
 +
***Med ED will do MSE
 +
===[[Harbor:Screening EMS Patients|Screening EMS Patients]]===
 +
===Administrative duties===
 +
**[[Harbor:Administrative resident|Administrative resident directions]]
 +
**[[Harbor: Phone Calls|Receiving Phone Calls]]
 +
***[[Harbor:Critical Result Callback|Critical Result Callback]]
 +
**[[Harbor:EKG screening|EKG Screening]]
 +
**[[Harbor:5S|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===
 +
===[[Harbor:RME & TRIAGE|RME & triage]]===
 +
**[[Harbor:Direct Admission after Hours]]
 +
**[[Harbor:Core Measures|Core Measures]]
 +
**[[Harbor:ED policy manual|Harbor ED policy manual]]
 +
**[[Harbor:ED attending on call plan|ED attending on call plan]]
 +
**[[Harbor:Legal|Harbor Legal]]
 +
**[[Harbor:Ophtho abbreviation dictionary]]
  
===Special patient types===
+
==Managing your Patient==
*[[Harbor:Occupational exposure|Occupational exposure]]
+
===General===
*Sepsis
+
====[[Harbor:PC Cheat Sheet|On shift (PC) Cheat Sheet]]====
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
 
**[[Harbor:Sepsis core measures|Sepsis core measures]]
 
*[[Harbor:Code stroke|Acute stroke]]
 
*[[Harbor:AVF/graft complications|AVF/graft complications]]
 
*[[Harbor:Respiratory isolation|Respiratory isolation]]
 
 
 
==Patient Disposition==
 
===[[Harbor:Discharge|Discharging a Patient]]===
 
*[https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]
 
*[[Harbor: ED Follow-Up Options|ED Follow-Up]]
 
*[[Harbor:Coumadin clinic|Coumadin clinic]]
 
*[[Harbor:Expedited workup clinic|Expedited workup clinic]]
 
*[[Harbor:Prescribing|Prescribing]]
 
  
===[[Harbor:Admitting a patient|Admitting a patient]]===
+
====[[Harbor:Paging|Paging consultants]]====
*[[Harbor:Admitting a patient|Admitting a patient]]
+
====[[Harbor:Phone numbers|Phone numbers]]====
*OBS & CORE
+
====[[Harbor:Radiology directory|Radiology directory]]====
**[[Harbor:Observation placement|Observation placement]]
 
**[[Harbor:CORE|CORE placement]]
 
  
*Admission Guidelines
+
===Tests & Orders===
**[[Harbor:Admission and consultation guidelines|Admission and consultation guidelines (Who goes to what service; policy 312)]]
+
*[[Harbor:Labs|Labs]]
***[[Harbor:Right level of care|Right level of care]]
+
*Radiology
***[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
+
====[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]====
***[[Harbor:C-Team|C-Team Admissions]]
+
*Ultrasound
***[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
+
**[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
**[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]]
+
**[[Harbor:Ultrasound Approval List|Ultrasound approval list]]
*[[Harbor:Direct Admission after Hours|Direct Admission after Hours]]
+
**[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
*Other
+
**Cleaning Endocavitary Probes
**[[Harbor:Deceased patients|Deceased patients]]
+
***Place in Red Bag (above probe cabinet in clean utility room)
**[[Harbor:Administrative resident|Transfers]]
+
***Place patient sticker on bag
*[[Harbor:Paging|Paging consultants]]
+
***Give to area charge nurse
 +
***Once cleaned, probe comes back in clear bag
 +
***T. Jang 8/2019
  
==[[Harbor:Disaster info|Disaster]]==
+
*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
*[[Harbor:Disaster info|General disaster info]]
+
*CT
*[[Harbor:Surge plan]]
+
**[[Harbor:Ordering a CT|Ordering a CT]]
*[[Harbor:Ebola|Suspected Ebola protocol]]
+
**[[Harbor:ED Radiology Specs|CT Specs]]
  
==See Also==
+
*Oral contrast
*[[Harbor:Operations manual]]
+
**No more gastrograffin, replaced by omnipaque. Must place an order for it. If you need to obtain a retrograde urethrogram, order a KUB.
*[[Harbor:VA MICU rotation]]
+
**Below is the suggested/usual volume of omnipaque used for certain indication sent to us by Dr. Putnam:
*[[Harbor:Teaching Rounds Topics]]
+
***For use in bowel obstruction, a volume of 100cc of Omnipaque 300 is used.
*[[Harbor:How to get started in research at Harbor]]
+
***For use in tube contrast studies, a volume anywhere between 50-200cc of Omnipaque 300 would likely be used.
*[[Harbor:RME Manual]]
+
***For a CT with po contrast, the order is for 30cc of Omnipaque 300 in 970cc of water.
*[[Harbor:Code STEMI]]
 
  
  
[[Category:Admin]]
+
====[[Harbor:STAT MRI|STAT MRI]]====
 +
*[[Harbor:ED Radiology Specs|MRI Specs]]
 +
*Other orders
 +
**[[Harbor:Ordering Blood Products|Blood products]]
 +
**Antibiotics
  
==Pre-hospital/Surge Plans==
+
====[[Harbor:Antibiogram|Antibiogram]]====
===[[Harbor:Incoming transfers|Incoming transfers]]===
+
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
===Ambulance Triage===
+
***[[Harbor:Sepsis core measures|Sepsis core measures]]
*[[Harbor:Screening EMS Patients|Screening EMS Patients]]
+
*Buprenorphine/Opiate Withdrawal Treatment
===Surge Criteria and Plan===
+
**[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
*[[Harbor:Surge Plan/Disasters|Harbor Surge Plan/Disasters]]
 
*[[Harbor:Disaster plan|Harbor disaster plan]]
 
 
 
===Orchid Downtime===
 
*[[Harbor:ORCHID Downtime|ORCHID Downtime]]
 
===ID:  Flu, Hepatitis, Ebola===
 
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
 
  
==[[Harbor:Labs|Labs]]==
+
==== Upload Outside Films to PACS====
 +
*Get form from clerk
 +
*Put patient sticker on Form
 +
*Check "Import"
 +
*Sign
  
==Radiology==
+
==== Get Images on Disc (For DC or Transfer)====
*[[Harbor:ED Radiology Specs|MRI Specs]]
+
*Same as upload EXCEPT
*[[Harbor:ED Radiology Specs|CT Specs]]
+
**Check "Export"
*[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
+
**Write time frame on form you want studies from
*[[Harbor:STAT MRI|STAT MRI]]
 
*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
 
  
==EQUIPMENT==
+
===Finding Equipment/DME===
 
*[[Harbor:Equipment|Equipment (AED/RME)]]
 
*[[Harbor:Equipment|Equipment (AED/RME)]]
 
*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
 
*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
===Ordering DME===
 
 
*[[Harbor:DME|Durable Medical Equipment (DME)]]
 
*[[Harbor:DME|Durable Medical Equipment (DME)]]
  
==IA/Exposures==
+
====[[Harbor:ED supplies A-Z|E supplies A-Z]]====
===[[Harbor:Occupational exposure|Occupational Exposure]]===
+
 
 +
===Procedures===
 +
*[[Harbor:Consenting a patient|Consenting a patient]]
 +
*[[Harbor:Procedures Videos|Procedure Videos]]
 +
 
 +
==Special patient types==
 +
*[[Harbor:Whole person care|Whole person care]]
 +
*[[Harbor:Social work|Social work]]
 +
*Activations
 +
**[[Harbor:Codes|Code Activations]]
 +
***[[Harbor:Involuntary holds|Involuntary holds]]
 +
**[[Harbor:Airway management team|Airway management team]]
 +
**[[Harbor:Code stroke|Code Stroke]]
 +
**[[Harbor:Code STEMI|STEMI Activation]]
 +
**[[Harbor:Trauma activations|Trauma Activations]]
 +
*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)]]
===Sexual Assult/STI Exposure===
+
*'''[[Harbor:Non-Occupational Exposure|Sexual Assault/STI Exposure (SART)]]'''
*[[Harbor:Non-Occupational Exposure|Sexual Assult/STI Exposure]]
+
*[[Harbor:PE Response Team|PE Response Team]]
 +
*[[Harbor:Psych patients|Psych Patients (Exodus)]]
 +
 
 +
===Others===
 +
*[[Harbor:AVF/graft complications|AVF/graft complications]]
 +
*[[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==
===F/up Flowchart===
+
===Discharge===
* https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]
 
===[[Harbor: ED Follow-Up Options|ED Follow-Up Clinics]]===
 
 
 
===[[Harbor:Discharge|Law Enforcement Escort]]===
 
 
*[[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====
 +
* '''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
 +
* 1B1
 +
* PAC (Patient Access Center) x64400
  
===Other===
+
===='''[[Harbor: ED Follow-Up Options|ED Follow-Up Clinics]]'''====
*[[Harbor:Deceased patients|Deceased patients]]
+
*'''[[Harbor:Forms|Forms]]'''
*[[Harbor:Transferring a patient|Transferring a patient]]
 
**[[Harbor:Transferring to psych ER|Transferring to psych ER]]
 
  
==Physicians==
+
*Follow-up of out patient labs/imaging
===[[Harbor:Forms|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:PC Cheat Sheet|PC Cheat Sheet]]===
+
*[[Harbor:Coumadin clinic|Coumadin clinic]]
 +
*[[Harbor:Expedited workup clinic|Expedited workup clinic]]
 +
*[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]]
 +
*[[Harbor:Home Health|Home Health]]
 +
*[[Harbor:Home hospice from ED]]
  
===[[Harbor:Phone numbers|Phone numbers]]===
+
===Social EM resources===
===[[Harbor:Paging]]===
+
*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
  
===[[Harbor:ED attending on call plan|ED attending on call plan]]===
+
===Admission===
 +
====[[Harbor:Admission and consultation guidelines|'''Admission Guidelines''']]====
 +
*[[Harbor:Admitting a patient|Admitting a patient]]
 +
*[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
 +
====[[Harbor:Interqual Override Notes|Interqual Override Notes]]====
  
===[[Harbor:Trauma activations|Trauma Activations]]===
+
====[[Harbor:Right level of care|Right level of care]]====
 +
*[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
 +
*[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]]
 +
*[[Harbor:Direct Admission after Hours|Direct Admission after Hours]]
 +
===OBS & CORE===
 +
*[[Harbor:Observation placement|Observation 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:Code STEMI|STEMI Activation]]===
+
===[[Harbor:Scheduled_dialysis_patients_in_ED|Dialysis in the ED]]===
*[[Harbor:EKG STEMI Screening|ECG STEMI screening]]
+
===Other Disposition===
 
+
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
===[[Harbor:Code stroke|Code Stroke]]===
+
* [[Harbor:Deceased patients|Deceased patients]]
 
+
*[[Harbor:Transferring a patient|Transferring a patient]]
===[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]===
+
**[[Harbor:Transferring to psych ER|Transferring to psych ER]]
 +
**[[Harbor:XRT|XRT transfers]]
 +
**[[Harbor:Replantation Patients|Replantation patient transfer]]
  
 
==Documentation==
 
==Documentation==
===[[Harbor:Attending documentation|Attending Documentation]]===
+
*[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]
 +
**[[Harbor: Macros and Autotext|Macros and Autotext]]
 +
*[[Harbor:Attending documentation|Attending Documentation]]
 +
*[[Harbor:Resident documentation|Resident documentation]]
 +
*[[Harbor:Consenting a patient|Consenting a Patient]]
 +
**[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]
  
===[[Harbor:Resident documentation|Resident documentation]]===
+
==Disaster & Surge==
 +
*[[Harbor:Disaster plan|Disaster plan]]
 +
*'''[[Harbor:Surge plan|Surge plan]]'''
 +
*[[Harbor:ORCHID Downtime|ORCHID Downtime]]
 +
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
 +
**[[Harbor:Ebola|Suspected Ebola protocol]]
  
 +
==Resident Education==
 +
*[[Harbor:Teaching Rounds Topics|Teaching Rounds Topics]]
 +
*[[Harbor:VA MICU rotation|VA MICU rotation]]
 +
*[[Harbor:How to get started in research at Harbor|How to get started in research at Harbor]]
 +
*[[Harbor:Jeopardy Policy|Jeopardy Policy]]
  
===[[Harbor:Prescribing|Prescribing]]===
+
==See Also==
 +
{{Special:Prefixindex/Harbor |hideredirects=1}}
  
===[[Harbor:Codes|Codes]]===
+
[[Category:Admin]]
 
 
===[[Harbor:Airway management team|Airway management team]]===
 
 
 
===[[Harbor: Macros and Autotext|Macros and Autotext]]===
 
 
 
==[[Harbor:RME & TRIAGE|RME & TRIAGE]]==
 
 
 
==[[Harbor:Social work|Social work]]==
 
 
 
===[[Harbor:Whole person care|Whole person care]]===
 
 
 
==[[Harbor:Core Measures|Core Measures]]==
 
 
 
==[[Harbor:ED policy manual|Harbor ED policy manual]]==
 

Latest revision as of 18:47, 5 January 2021

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

Admin Updates

  • Coronavirus (COVID-19) Info
    • Visitor Policy:
      • End of life: 1 visitor at a time, 2 visitors per day, up to 4 hours total
      • ALOC/disruptive behavior: 1 visitor at discretion of clinical team
      • ICU: 1 per day, 2 hours max
      • Peds: 1 visitor/guardian
      • Consult IPC if visitor has COVID or COVID exposure
  • New Flu diagnosis and treatment algorithm for 2020-21 File:Flu Dx and Tx algorithm 2020-21 V.2 final.pdf
  • OBS Update (6/2/2020) - for patients being admitted to the new short-stay medicine team, page the ED hospitalist at 204-9753, order "PLACE IN OBS" (just like we did pre-COVID); the medicine team will order the "request for admit" once they get the COVID test results. Drs. Spiegel & Chappell

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

Enter Prelim Rads Read

  • Oral contrast
    • No more gastrograffin, replaced by omnipaque. Must place an order for it. If you need to obtain a retrograde urethrogram, order a KUB.
    • Below is the suggested/usual volume of omnipaque used for certain indication sent to us by Dr. Putnam:
      • For use in bowel obstruction, a volume of 100cc of Omnipaque 300 is used.
      • For use in tube contrast studies, a volume anywhere between 50-200cc of Omnipaque 300 would likely be used.
      • For a CT with po contrast, the order is for 30cc of Omnipaque 300 in 970cc of water.


STAT MRI

Antibiogram

Upload Outside Films to PACS

  • Get form from clerk
  • Put patient sticker on Form
  • Check "Import"
  • Sign

Get Images on Disc (For DC or Transfer)

  • Same as upload EXCEPT
    • Check "Export"
    • Write time frame on form you want studies from

Finding Equipment/DME

E supplies A-Z

Procedures

Special patient types

Others

Patient Disposition

Discharge

Empanelment

  • 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
  • 1B1
  • PAC (Patient Access Center) x64400

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)

Social EM resources

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

Admission

Admission Guidelines

Interqual Override Notes

Right level of care

OBS & CORE

  • Observation placement
  • CORE placement
  • Observation Patients Direct from UCC
    • Do not need an ED MSE - can go direct to OBS
    • If no OBS beds available in GOLD - should be made Direct Admits to the Hospital

Peterson 8/2019

Dialysis in the ED

Other Disposition

Documentation

Disaster & Surge

Resident Education

See Also