Difference between revisions of "Harbor:Main"

(Admission)
(ED Follow-Up Clinics)
 
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==Admin Updates==
 
==Admin Updates==
 
* [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
 
* [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
 +
** Visitor Policy:
 +
*** 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]]
  
 
*Transitional Dialysis in the ED/5W,Room10:  [[Harbor:Scheduled_dialysis_patients_in_ED]]  Starting Wednesday, 7/8/2020
 
*Transitional Dialysis in the ED/5W,Room10:  [[Harbor:Scheduled_dialysis_patients_in_ED]]  Starting Wednesday, 7/8/2020
 
*GOLD closed for ED use. Only for inpatient boarders
 
  
 
*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  
 
*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  
  
 
*[https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines|Updated Admission and Consultation Guidelines - May 2020]
 
*[https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines|Updated Admission and Consultation Guidelines - May 2020]
 
* Whole Blood coming 5/11 (ED fridge) - limited to use for trauma patients, 2 units max per patient
 
  
 
* 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)
 
* 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)
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*[[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]
 
**[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
 +
 
===='''[[Harbor: ED Follow-Up Options|ED Follow-Up Clinics]]'''====
 
===='''[[Harbor: ED Follow-Up Options|ED Follow-Up Clinics]]'''====
 
*'''[[Harbor:Forms|Forms]]'''
 
*'''[[Harbor:Forms|Forms]]'''
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**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)
 
**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]]
 +
 +
===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
 
*[[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 and Trauma Recovery Center]]
*[[Harbor:Coumadin clinic|Coumadin clinic]]
+
*Whole Person Care (WPC) autopage in Cerner, p0145, refer 24/7.
*[[Harbor:Expedited workup clinic|Expedited workup clinic]]
+
**Substance use disorders (SUD)
*[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]]
+
***Available SUD counselor in person Mon 8a-5p, T-F 8a-1230a, Sat 4p-1230a.
*[[Harbor:Home Health|Home Health]]
+
***Otherwise will follow up next business day via phone call. Need good contact phone number. Ensure patient knows you put a referral and someone will be contacting them.
 +
***On discharge, include the WPC discharge instructions (“Whole Person Care Harbor-UCLA”, also available in Spanish) from ORCHID
 +
**Medically Complex Transitions of care (includes 3 visits to ED in past year)
 +
***1) ORCHID Message/Call/Text Lelalee Vicedo - Social Work Supervisor. Please include MRN, pt phone number, and reason for referral. (213) 572-9895. She will respond M-F 9:00-4:30 pm but you can ORCHID message/call/text/email anytime.
 +
***AND 2) place order in ORCHID: Consult to Social Work: reason for referral = other, free text WPC TOC
 +
*Re-entry (released from prison <6 months with medical, mental health, substance abuse, or social needs) 844.804.5200 (24/7) and put patient on phone.
 +
*Food Pharmacy, free fruits and vegetables every Wednesday 9a-1p outside front entrance of S/E building
 +
*Free cell phones:
 +
**Lifeline free phones: Outside of S/E building 8a-6p (Monday - Sat)
 +
**Social work has a limited number
 +
*Mental Health
 +
**Residential & Bridging Care (transition from mental health institution to community) 213.738.4775
 +
**Intensive Service Recipients (mental health with 2 or more admissions in year, recent DC from psych hospital) 844.804.5200
 +
*Perinatal (high-risk pregnant mothers - homeless, mental health, substance abuse, domestic violence, no food) Mama's Program844.376.2627
  
 
===Admission===
 
===Admission===
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*[[Harbor:Admitting a patient|Admitting a patient]]
 
*[[Harbor:Admitting a patient|Admitting a patient]]
 
*[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
 
*[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
 +
====[[Harbor:Interqual Override Notes|Interqual Override Notes]]====
 +
 
====[[Harbor:Right level of care|Right level of care]]====
 
====[[Harbor:Right level of care|Right level of care]]====
 
*[[Harbor:Internal Medicine Admissions|Internal Medicine Admission Template]]
 
*[[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]]

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