Harbor:Operations manual: Difference between revisions
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Revision as of 05:18, 31 January 2019
Pre-hospital/Surge Plans
Incoming transfers
Ambulance Triage
Surge Criteria and Plan
Orchid Downtime
ID: Flu, Hepatitis, Ebola
Labs
Radiology
EQUIPMENT
Ordering DME
IA/Exposures
Occupational Exposure
Sexual Assult/STI Exposure
Patient Disposition
F/up Flowchart
- https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]
ED Follow-Up Clinics
Law Enforcement Escort
Other
ADMISSIONS
Admission Policy
OBS & CORE
Admission Guidelines
- Admission and consultation guidelines (policy 312)
- Post-admission management/Orders on Admitted Patients
Boarding Patients Sent from Clinic
Just a reminder to the seniors in the Emergency Department running the board: the correct procedure for patients admitted from clinic who do not need a monitored bed, especially when the clinic is closing, is for the clinic to contact the patient flow facilitator to assist in locating a bed in the hospital, and only contact the emergency department to board the patient if the flow facilitator cannot make other arrangements.
Monitored bed patients can be sent from the clinic to the emergency department to board when we are out of monitored beds. If it does not sound like the patient needs a monitored bed, please talk to the ED attending.
(Dir. OPS, February 03, 2015)
Direct Admission after Hours
Insurance Problems
- For issues with insurance, refer patients to the CA Dept of Managed Healthcare: https://www.dmhc.ca.gov/
Physicians
Forms
PC Cheat Sheet
Phone numbers
Harbor:Paging
ED attending on call plan
Trauma Activations
In addition to the standard trauma activation criteria published on a badge card that everyone should carry and refer to, the Trauma Service can be activated in patients not meeting trauma criteria to help in several ways:
- Getting CT scans READ quickly (Trauma will read them)
- Getting lots of extra hands to do whatever needs to be done for the patient.
- Getting surgical decisions made more quickly.
You can even activate the trauma service if you have a non-trauma patient that needs emergent surgical intervention.
All of these decisions are covered under "ED Judgment"
(Dir OPS 7/15)
STEMI Activation
Code Stroke
Scheduled Dialysis Patients in ED
- The router will place them on the pre-arrivals each AM (M/W/F)
- HD times should be 5-9a and 930-130p
- They will receive a MSE at triage – if they decline the MSE and only want their scheduled HD, please document that “the patient declined a MSE and no emergent medical condition exists at this time” in the MSE note and we are done from the ED perspective
- If the patient appears unstable, please discuss with one of the AED attendings to determine if they need to be on an AED team or simply need dialysis with a call to the nephrologist for urgent evaluation.
- Once the MSE is performed, they will be taken to one of our HD rooms – preferentially Gold 29, then RME 19, then Acute 15 (likely a max of 2 rooms at a time).
- They will be cared for by the nephrologist (typically Dr. Anuja Shah) who will place the discharge orders (so these patients should NOT be placed on AED teams).
- If for some reason Dr. Shah is unable to evaluate the patient prior to discharge, the FastTrack NP (not resident) will briefly evaluate the patient when ready for discharge - documenting vitals, heart, lung, and lower extremity exam, and page Dr. Shah to clear for dispo and subsequently print the discharge instructions (“HEMODIALYSIS” patient education).
- The NP will forward the chart to Dr. Shah, not ED R4 or Attending.
Chappell 12-1-17
ED Procedure Videos
- LP
- Para ...