Harbor:Main

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

Admin Updates

Frequently used resources

OLD TOPICS

ED Request for Specialty Appointment order is live 7/25/2023! No more black star in the depart menu.
- Referral Guidance Summary Sheet
- Details for Specific Clinics
- How to Make an Appointment: File:ED Request for Specialty Appointment Hot Sheet 7-25-2023.pdf

Happy July 4th: Hand Replant Transfers to LAG

Ortho Follow-up Guidelines (5-2023)

QR Code Resources
- For Staff (Equipment, EMS, Med Student Evals)
- For Patients

Hyperbaric treatment for CO
- Options - UCLA Westwood, Long Beach Memorial, UCSD, NOT MAC to Catalina (only for dive injuries)
- UR coordinates the acceptance
- Transfers: UR should help coordinate the transfer - ELTC/HLOC - needs to occur <1-2 hrs
  - Sending facility is supposed to arrange transfer
  - If UR not able to get transfer in a timely manner --> MAC (CDO) - must be approved by house supervisor & Joy; BLS/ALS/CC transport
    - Medics can call the radio for online base medical direction/orders

New Expedited Work up Clinic referral process: https://www.wikem.org/wiki/Harbor:Expedited_Work-up_Clinic_(EWC)
New asthma guidelines
- The preferred DHS controller medication is Symbicort (formeterol – long-acting B-agonist + budesonide – inhaled corticosteroid), 2nd line is Advair (salmeterol + fluticasone).
- If seeing the patient in the ED for an asthma exacerbation, please be sure to refill their controller medication AND the albuterol (if needed). We fall out if they fill more albuterol Rx’s in a year than their controller medication, so we need to make sure they get both when seen in the ED. If prescribing albuterol, do not give refills (you get 200 puffs!).
Sepsis – remember to do the required components of the sepsis core measure w/in 3 hrs (30ml/kg, bcx, abx), document using the auto text (use “auto text copy utility” to get Brad Chappell’s “ .harsepsis” to go through the reminder guidance text and exclusions for IVF 30ml/kg. Communicate to the admitting team if they need to repeat the lactate and perform the sepsis reassessment exam with time stamp (w/in 6 hrs).
If UR is suggesting a transfer to Rancho Los Amigos (RLA), then place the ‘consult to Transfer Center’ order. The Transfer Center is a county entity that helps transfer patients between county facilities.

Synapse got a new look. See link for details. A one-page intro guide are available on DHS SharePoint
- Alt+C still works to compare studies.
- Open the PowerJacket (folder icons) and then you can pull up the read on 'reports'. Click the dropdown to switch from 'report' to 'notes' to find a free text prelim read.
- Change your default settings to what PowerJacket looks like and select ‘Notes’ and ‘Reports’ to always open so you can see prelim and final reads, respectively.
Patient Relations Representatives (PRR) 3p-2a, 7days a week – call Registration for PRR who can help empanel into DHS or change empanelment/network in real time in the ED. PRR can come to bedside to meet with patient or send patient to Registration Windows. During business hours, send patient to Patient Relations Office in Rm 1-B-1.

Harbor's COVID page Coronavirus (COVID-19) Info
- Paxlovid, Remdesivir, etc ... COVID Treatment Options

Interqual criteria Interqual Criteria Tips

Monkeypox
- See Monkeypox for medical information & Harbor Monkeypox Plan
- Educational Material

Active Threat in the ED
- Situational awareness
  - Stand between door and patient
  - Ensure patient is gowned
  - Be aware of long stethoscope, lanyard, long hair, etc
  - Panic buttons at nursing stations/router
  - Run & scream for help
- Hospital Codes
  - Gold x111 - combative/agitated patient
  - Gray x64450 - combative/agitated NON-patient
  - Silver x111 - weapon, active shooter, hostage

General Administrative

Pre-hospital
- Incoming transfers
- Exodus Transfers
  - Exodus should call Psych ED about transfer, not Med ED
  - Med ED will do MSE
DEM AOD DEM Admin on Duty (AOD)
Resident Responsibilities

Ambulance (EMS) Triage

Administrative duties

Administrative resources

RME & triage

Harbor ED policy manual

ED attending on call plan

Harbor Legal

Managing your Patient

General

On shift (PC) Cheat Sheet

Paging consultants

Harbor:Ophtho abbreviation dictionary

Phone numbers

Radiology directory

Tests & Orders

Labs

Radiology

Radiology Hours

[Radiology Directory]

US & QPathE

QPathE Login link
- Login using e# and associated password
- Double-click the exam
- Click "edit" at the top of the page
- Enter MRN in the "patient ID" box
- in "comments" enter trauma FAST
- Click save at top of screen

Contrast

Urgent Outpatient IR

STAT MRI

MRI Specs

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

Blood products

Antibiogram

- Harbor antibiotics in sepsis
  - Sepsis core measures

Finding Equipment/DME

ED supplies A-Z

Procedures

Special patient types

Code Activations

Placement patients

Psych Patients, Code Gold, & Exodus

Scheduled dialysis patients in ED

Sexual Assault/STI Exposure (SART)

Occupational Exposure

Industrial or On-the-Job Accidents (IA)

Harbor Radiation Precautions

NFL Injured Player/Staff Protocol

Substance Use Disorder (SUD) Treatment Options

Infectious Disease Threats

Social Work

Crown Checks

Screening L & D patients: If a pregnant person is brought back to the PED for an evaluation, it should be for active labor and the urge to push.
- If the pregnant person has the urge to push, we are doing a crown check – that is looking to make sure the head is not visible. We are not doing a complete internal exam. If no head is visible and everything else seems okay, we do a quick MSE note and the patient is sent upstairs to L & D after the nurses call up and let them know they are coming up.
- Caveats:
  - If the pregnant person is having contractions and the baby appears to be premature below 37 weeks (especially less than 32 weeks) and delivery seems to be imminent (water broke, contractions very close together, etc) consider calling OB batch as the baby can be born through only a partially dilated cervix with little pushing. We do not want this to happen in the elevator.
  - If the birthing person has had multiple pregnancies/deliveries, the baby can be born rather quickly; be more conservative in your clinical judgement to transfer to OB.
  - Vaginal bleeding – if the birthing person is having significant vaginal bleeding, then OB should be called down to us for evaluation – using the OB batch pager gets them down quickly.
  - Please use your medical knowledge to determine the risk to the birthing person and the chances the baby could be born in the elevator. If in doubt call OB batch page for OB to come down to evaluate the situation (I frequently have them come down for micropremies to check to see how imminent delivery is rather than sending upstairs with the risk of delivering in the elevator).