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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==
*EWC - 8/5/19 - back to scheduling directly into EWC; Cerner is working again!
+
*Ortho - who to splint and schedule for f/up without consulting
*Surge Criteria Pilot - 7/10/19:  ED census for surge criteria includes R5, R6, R7, & R12;  Available med/surg '''OR''' ICU/PCU
+
** [[Harbor:ED_follow-up_options#ORTHO|Harbor Ortho Follow-up]]
(Dr. Peterson, Dr. Stein, Mark Redulla [pt flow])  
+
 
*PERT (PE Response Team) Started Monday 6/24
+
*  '''COVID VACCINES AVAILABLE to ALL PATIENTS 12 and older with ORCHID MRN''': 
** Page the PERT Fellow p9956 for (sub)massive PE when considering thrombolytics
+
** both Pfizer and Janssen now available in ED on the Quick Order page "Med Immunization COVID Subphase"
** for detailshttps://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Pulmonary_Embolus
+
** https://wikem.org/wiki/Harbor:Infectious_Disease_Threats#Vaccines
 +
 
 +
 
 +
* '''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)
 +
** GoalReduce 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.
 +
 
 +
 
 +
* [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
 +
** [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 DHS Visitor Policy 6/15/21]
 +
*** 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'''"
 +
 
 +
 
 +
* ReminderKeep HL patients on track in AWR and HL Taskforce will DC once the patient has been seen and all SW issues addressed
 +
 
 +
 
 +
*  [[Harbor:Admission_and_consultation_guidelines|Admission Guidelines - Revised May 2020]]
  
 
==General Administrative==
 
==General Administrative==
 
*Pre-hospital
 
*Pre-hospital
 
**[[Harbor:Incoming transfers|Incoming transfers]]
 
**[[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]]===
 
===[[Harbor:Screening EMS Patients|Screening EMS Patients]]===
*Administrative duties
+
===Administrative duties===
 
**[[Harbor:Administrative resident|Administrative resident directions]]
 
**[[Harbor:Administrative resident|Administrative resident directions]]
 
**[[Harbor: Phone Calls|Receiving Phone Calls]]
 
**[[Harbor: Phone Calls|Receiving Phone Calls]]
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**[[Harbor:EKG screening|EKG Screening]]
 
**[[Harbor:EKG screening|EKG Screening]]
 
**[[Harbor:5S|Pre-shift: 5S]]
 
**[[Harbor:5S|Pre-shift: 5S]]
*Administrative resources
+
**Airway Bag
**[[Harbor:RME & TRIAGE|RME & triage]]
+
***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:Direct Admission after Hours]]
 
**[[Harbor:Core Measures|Core Measures]]
 
**[[Harbor:Core Measures|Core Measures]]
**[[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]]===
 +
**[[Harbor:Ophtho abbreviation dictionary]]
  
 
==Managing your Patient==
 
==Managing your Patient==
 
===General===
 
===General===
====[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]====
+
====[[Harbor:PC Cheat Sheet|On shift (PC) Cheat Sheet]]====
 +
 
 
====[[Harbor:Paging|Paging consultants]]====
 
====[[Harbor:Paging|Paging consultants]]====
 
====[[Harbor:Phone numbers|Phone numbers]]====
 
====[[Harbor:Phone numbers|Phone numbers]]====
 
+
====[[Harbor:Radiology directory|Radiology directory]]====
  
 
===Tests & Orders===
 
===Tests & Orders===
 
*[[Harbor:Labs|Labs]]
 
*[[Harbor:Labs|Labs]]
*Radiology
+
====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
 +
**** Can also directly login to their website:  [https://clients.statrad.com/Account/Login?ReturnUrl=%2f StatRad]  --> Main tab --> review exams & images --> can search by name or MRN
 +
***** Call Dr. Chappell for login information
 +
** 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]]====
 
====[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]====
 
*Ultrasound
 
*Ultrasound
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**[[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
 +
**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.
  
 
====[[Harbor:STAT MRI|STAT MRI]]====
 
====[[Harbor:STAT MRI|STAT MRI]]====
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*Buprenorphine/Opiate Withdrawal Treatment
 
*Buprenorphine/Opiate Withdrawal Treatment
 
**[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
 
**[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
 +
 +
==== 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===
 
===Finding Equipment/DME===
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*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
 
*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
 
*[[Harbor:DME|Durable Medical Equipment (DME)]]
 
*[[Harbor:DME|Durable Medical Equipment (DME)]]
 +
 +
====[[Harbor:ED supplies A-Z|E supplies A-Z]]====
  
 
===Procedures===
 
===Procedures===
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==Special patient types==
 
==Special patient types==
===[[Transferring_to_psych_ER#Guidelines_for_Flow_of_patients_between_the_Psychiatric_and_Adult_Emergency_Departments_.28ED_Policy_3.4.29]]
+
===[[Harbor:Whole person care|Whole Person Care]]===
*[[Harbor:Whole person care|Whole person care]]
+
===[[Harbor:Social work|Social Work]]===
*[[Harbor:Social work|Social work]]
+
===[[Harbor:Codes|Code Activations]]===
*Activations
+
*[[Harbor:Involuntary holds|Involuntary Holds]]
**[[Harbor:Codes|Code Activations]]
+
*[[Harbor:Airway management team|Airway Management Team]]
***[[Harbor:Involuntary holds|Involuntary holds]]
+
*[[Harbor:Code stroke|Code Stroke]]
**[[Harbor:Airway management team|Airway management team]]
+
*[[Harbor:Code STEMI|STEMI Activation]]
**[[Harbor:Code stroke|Code Stroke]]
+
*[[Harbor:Trauma activations|Trauma Activations]]
**[[Harbor:Code STEMI|STEMI Activation]]
+
===Sepsis===
**[[Harbor:Trauma activations|Trauma Activations]]
+
*[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
*Sepsis
+
===[[Harbor:Sepsis core measures|Sepsis core measures]]===
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
+
==='''[[Harbor:Occupational exposure|Occupational Exposure]]'''===
**[[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: Identifying Jane/John Doe, finding next of kin tips]]
 
===Others===
 
===Others===
 
*[[Harbor:AVF/graft complications|AVF/graft complications]]
 
*[[Harbor:AVF/graft complications|AVF/graft complications]]
 
*[[Harbor:Respiratory isolation|Respiratory isolation]]
 
*[[Harbor:Respiratory isolation|Respiratory isolation]]
*[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]
+
===[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]===
 
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
 
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
**[[Harbor:Ebola|Suspected Ebola protocol]]
+
===[[Harbor:Infectious_Disease_Threats#Coronavirus_.28COVID-19.29|'''COVID''']]===
 +
*[[Harbor:Ebola|Suspected Ebola protocol]]
 
*[[Harbor:Replantation Patients|Replantation Patients]]
 
*[[Harbor:Replantation Patients|Replantation Patients]]
 
*[[Harbor:XRT|XRT transfers]]
 
*[[Harbor:XRT|XRT transfers]]
Line 105: Line 242:
 
*[[Harbor:Prescribing|Prescribing]]
 
*[[Harbor:Prescribing|Prescribing]]
 
*[[Harbor: ED Follow-Up Options|ED Follow-Up]]
 
*[[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]
+
 
*'''[[Harbor: ED Follow-Up Options|ED Follow-Up Clinics]]'''
+
====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]]'''====
 
*'''[[Harbor:Forms|Forms]]'''
 
*'''[[Harbor:Forms|Forms]]'''
 +
 +
====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)
 +
 +
*[[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]]
 +
 +
===Transportation Needs===
 +
*BUS/METRO TAP CARDS:
 +
**8a-5p - send to Social Work Office
 +
**Nights/weekends/holidays - ED RN can get from the House Supervisor x65620 or spectra 23721 who will deliver the voucher to the ED
 +
 +
* TAXI VOUCHERS: Must have a place to go with keys/someone home, or a shelter where patient is already accepted
 +
** Daytime - call Social Work to facilitate
 +
** Night/Weekend/Holidays - call house supervisor x65620 or spectra 23721 who will deliver the voucher to the ED
 +
*** RN calls taxi - must notify taxi if needs wheelchair accessibility (Yellow Cab @ 310-533-6800)
 +
*** RN takes the patient to the hospital nursing office; taxi driver comes to nursing office to sign paperwork and pick up the patient
 +
 +
* UBER/LYFT:
 +
**Similar to above Taxi Vouchers
 +
**Available to patient's without insurance who do not have other transportation options
 +
 +
* AMBULANCE:  for patients that have a medical necessity (cannot ambulate, here w/o wheel chair, etc) and medically cannot take a taxi
 +
* ED RN & area clerk to coordinate with insurance (if applicable)
 +
* If patient is UNINSURED (including restricted Medi-Cal) - use county transport to get an ambulance home
 +
** UR & SW can get involved if issues
 +
** If patient lives outside of LA County, call nursing supervisor or SW as they may need further authorization
 +
*** Joy Lagrone can authorize county transport as a last resort
 +
 +
*Kids without car seats: For kids who arrive (usually by ambulance) w/o a car seat, we do not have car seats available.  however, options are:
 +
# Take the bus home (no need for car seat)
 +
# Have someone bring a car seat and pick them up or go home in a taxi with the car seat that is brought in
 +
# If either of above options is not possible, may 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:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
*[[Harbor:Substance Use Disorder|Substance Use Disorder]]
 
 
*[[Harbor:Medical Legal Partnership|Medical Legal Partnership]]
 
*[[Harbor:Medical Legal Partnership|Medical Legal Partnership]]
 
*[[Harbor:Immigration Legal Assistance|Immigration Assistance]]
 
*[[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]]
+
*[[Harbor:Hospital Based Violence Intervention Program and Trauma Recovery Center|Hospital Based Violence Intervention Program (HBVIP) and Trauma Recovery Center (TRC)]]
*[[Harbor:Coumadin clinic|Coumadin clinic]]
+
*[[Harbor:Whole person care|Whole Person Care (WPC)]] autopage in Cerner (p0145), refer 24/7.
*[[Harbor:Expedited workup clinic|Expedited workup clinic]]
+
**[[Harbor:Substance Use Disorder|Substance Use Disorder (SUD)]]
*[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]]
+
***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 Abuse", "MAT", or "TOC" 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)
 +
***[https://www.assurancewireless.com/lifeline-services/how-qualify Assurance Wireless]
 +
**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===
*'''[[Harbor:Admission and consultation guidelines|Admission and consultation guidelines]]'''
+
====[[Harbor:Admission and consultation guidelines|'''Admission Guidelines''']]====
 
*[[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:Right level of care|Right level of care]]
+
====[[Harbor:Interqual Override Notes|Interqual Override Notes]]====
 +
 
 +
====[[Harbor:Right level of care|Right level of care]]====
 
*[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
 
*[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
 
*[[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]]
Line 134: Line 351:
 
Peterson 8/2019
 
Peterson 8/2019
  
 +
===[[Harbor:Scheduled_dialysis_patients_in_ED|Dialysis in the ED]]===
 
===Other Disposition===
 
===Other Disposition===
 
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
 
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
Line 161: Line 379:
 
*[[Harbor:VA MICU rotation|VA MICU rotation]]
 
*[[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:How to get started in research at Harbor|How to get started in research at Harbor]]
 +
*[[Harbor:Jeopardy Policy|Jeopardy Policy]]
  
 
==See Also==
 
==See Also==
*[[Harbor:RME Manual]]
+
{{Special:Prefixindex/Harbor |hideredirects=1}}
  
 
[[Category:Admin]]
 
[[Category:Admin]]

Latest revision as of 19:23, 27 July 2021

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

Admin Updates


  • 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.


  • Coronavirus (COVID-19) Info
    • DHS Visitor Policy 6/15/21
      • 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
        • Can also directly login to their website: StatRad --> Main tab --> review exams & images --> can search by name or MRN
          • Call Dr. Chappell for login information
    • 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

Social Work

Code Activations

Sepsis

Sepsis core measures

Occupational Exposure

Sexual Assault/STI Exposure (SART)

Others

Scheduled dialysis patients in ED

COVID

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 (HBVIP) and Trauma Recovery Center (TRC)
  • 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 Abuse", "MAT", or "TOC" 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