Difference between revisions of "Harbor:Main"

(Task-Specific Pages)
(Admin Updates)
 
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==Background==
+
''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 mainpage for Harbor-UCLA Residency Administration Section.
+
==Admin Updates==
 +
* [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
  
==Task-Specific Pages==
+
*Transitional Dialysis in the ED/5W,Room10:  [[Harbor:Scheduled_dialysis_patients_in_ED]]  Starting Wednesday, 7/8/2020
*[[Harbor: Administrative Resident Role|General Administrative]]
+
 
**[[Harbor: Phone Calls|Recieving Phone Calls]]
+
*GOLD closed for ED use. Only for inpatient boarders
**[[Harbor: Triaging Ambulance Runs|Triaging Ambulance Runs]]
+
 
**[[Harbor: Disaster Info|Disaster Info]]
+
*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
*Getting Started
+
 
**[[Harbor: IT Basics|IT Basics]]
+
*[https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines|Updated Admission and Consultation Guidelines - May 2020]
**Initiating Patient Contact
+
 
*Managing your Patient
+
* Whole Blood coming 5/11 (ED fridge) - limited to use for trauma patients, 2 units max per patient
**Ordering
+
 
***[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
+
* 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: Ultrasound Approval List]]
+
** please use the EC7 as needed (Na, K, iCa, H/H, pH, CO2, pO2, HCO3, base excess)
***[[Harbor:Ordering a CT|Ordering a CT]]
+
** You will have to wait for serum lactate from lab
***[[Harbor:Ordering Blood Products|Ordering Blood Products]]
+
** https://www.pointofcare.abbott/shared/static-assets/other/APOC2020-001%20CHEM8+%20CG4+%20capillary%20and%20CLIA%20notification%20letter%20FINAL.pdf
**Documenting
+
 
***[[Harbor: Consenting a Patient|Consenting a Patient]]
+
==General Administrative==
**Finding Things
+
*Pre-hospital
***[[Harbor:Forms|Forms]]
+
**[[Harbor:Incoming transfers|Incoming transfers]]
***[[Harbor:Equipment|Equipment]]
+
**Exodus Transfers
***[[Harbor:Paging|Find a Consult]]
+
***Exodus should call Psych ED about transfer, not Med ED
***[[Harbor: Lookup Patient Information|Lookup Patient Information]]
+
***Med ED will do MSE
*Patient Disposition
+
===[[Harbor:Screening EMS Patients|Screening EMS Patients]]===
**[[Harbor:Discharging a Patient|Discharging a Patient]]
+
===Administrative duties===
***[[Harbor: ED Follow-Up Options]]
+
**[[Harbor:Administrative resident|Administrative resident directions]]
***[[Harbor:Prescribing|Prescribing]]
+
**[[Harbor: Phone Calls|Receiving Phone Calls]]
**Admitting a Patient
+
***[[Harbor:Critical Result Callback|Critical Result Callback]]
***[[Harbor:C-Team|C-Team Admissions]]
+
**[[Harbor:EKG screening|EKG Screening]]
***[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
+
**[[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]]
 +
 
 +
==Managing your Patient==
 +
===General===
 +
====[[Harbor:PC Cheat Sheet|On shift (PC) Cheat Sheet]]====
 +
 
 +
====[[Harbor:Paging|Paging consultants]]====
 +
====[[Harbor:Phone numbers|Phone numbers]]====
 +
====[[Harbor:Radiology directory|Radiology directory]]====
 +
 
 +
===Tests & Orders===
 +
*[[Harbor:Labs|Labs]]
 +
*Radiology
 +
====[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]====
 +
*Ultrasound
 +
**[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
 +
**[[Harbor:Ultrasound Approval List|Ultrasound approval list]]
 +
**[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
 +
**Cleaning Endocavitary Probes
 +
***Place in Red Bag (above probe cabinet in clean utility room)
 +
***Place patient sticker on bag
 +
***Give to area charge nurse
 +
***Once cleaned, probe comes back in clear bag
 +
***T. Jang 8/2019
 +
 
 +
*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
 +
*CT
 +
**[[Harbor:Ordering a CT|Ordering a CT]]
 +
**[[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.
 +
 
 +
 
 +
====[[Harbor:STAT MRI|STAT MRI]]====
 +
*[[Harbor:ED Radiology Specs|MRI Specs]]
 +
*Other orders
 +
**[[Harbor:Ordering Blood Products|Blood products]]
 +
**Antibiotics
 +
 
 +
====[[Harbor:Antibiogram|Antibiogram]]====
 +
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
 +
***[[Harbor:Sepsis core measures|Sepsis core measures]]
 +
*Buprenorphine/Opiate Withdrawal Treatment
 +
**[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
 +
 
 +
==== Upload Outside Films to PACS====
 +
*Get form from clerk
 +
*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===
 +
*[[Harbor:Equipment|Equipment (AED/RME)]]
 +
*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
 +
*[[Harbor:DME|Durable Medical Equipment (DME)]]
 +
 
 +
====[[Harbor:ED supplies A-Z|E supplies A-Z]]====
 +
 
 +
===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:Non-Occupational Exposure|Sexual Assault/STI Exposure (SART)]]'''
 +
*[[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==
 +
===Discharge===
 +
*[[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]
 +
===='''[[Harbor: ED Follow-Up Options|ED Follow-Up Clinics]]'''====
 +
*'''[[Harbor:Forms|Forms]]'''
 +
 
 +
*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:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
 +
*[[Harbor:Substance Use Disorder|Substance Use Disorder]]
 +
*[[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]]
 +
*[[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]]
 +
 
 +
===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: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:Scheduled_dialysis_patients_in_ED|Dialysis in the ED]]===
 +
===Other Disposition===
 +
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
 +
* [[Harbor:Deceased patients|Deceased patients]]
 +
*[[Harbor:Transferring a patient|Transferring a patient]]
 +
**[[Harbor:Transferring to psych ER|Transferring to psych ER]]
 +
**[[Harbor:XRT|XRT transfers]]
 +
**[[Harbor:Replantation Patients|Replantation patient transfer]]
 +
 
 +
==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]]
 +
 
 +
==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]]
  
 
==See Also==
 
==See Also==
*[[Harbor: Operations Manual]]
+
{{Special:Prefixindex/Harbor |hideredirects=1}}
  
 
[[Category:Admin]]
 
[[Category:Admin]]

Latest revision as of 23:52, 11 September 2020

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

Admin Updates

  • 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
  • Whole Blood coming 5/11 (ED fridge) - limited to use for trauma patients, 2 units max per patient

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

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)

Admission

Admission Guidelines

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