Harbor:Receiving phone calls
Abnormal Lab/Radiology Callbacks
- Search for patient in Orchid to see if still in ED, discharged, or admitted
- If admitted, tell the tech/rads that they need to call the admitting doctor by calling up to the floor
- Check out what was done for the patients in Provider Notes
- If patient was sent home and you feel they need to be recontacted look up patient contact info - go to Demographics tab in Orchid. If you cannot get a hold of patient, can fill out "telegram" form (on Harbor Intranet → Departments → Emergency Department ) and then give it to the clerk.
Tips for abnormal lab/radiology calls
- Call the patient- Look in the patient demographics section of Orchid for the patient's phone number. Call patient and give appropriate follow-up information. If you are not sure what kind of follow-up advice to give the patient - ask your attending (and document that you discussed the follow-up with your attending). Document your attempt to call.
- Mail notification - If the patient is not available to speak with - send a mail notification. This is true even if you leave a message (either on an answering machine or with another person), as there is no guarantee the patient will ever receive that message! Make sure any messages are HIPPA compliant.
- To do a mail notification fill out the "telegram form" (available on our website) and give it to the clerk. The message should say something like "We have test results from your recent visit to the ER at Harbor that we need to discuss with you (right away/as soon as possible/etc.) Please call 310 222-3500 and tell the clerk you were informed to call back the ER and need to speak to the doctor." Mail notifications may take several days or longer. Document that you submitted a mail notification.
- Welfare Check - if the patient can not be reached and the timing of the follow-up is critical (especially in light of mail notification which takes several days) - call the police department in the city where the patient's address is to request the police perform a "Welfare Check". This is where the police actually go to the patients home. Explain the dispatcher how important it is that patient return to the ER and the timeframe. (The police do not need to know or have a right to know the specifics of the patient's medical condition - but its important they know the danger the patient may be in.) Record the name and badge number of the officer you speak to in ORCHID. The police may or may not perform the check - it is their decision based on their workload, but taking their info may help them take responsibility.
Outside clinics, MLK, Hubert-Humphrey transfers
- We generally do not refuse any transfers
- However, if the patient is unstable, they should call 911 and go to the nearest hospital
- Inform the charge nurse that there is someone coming and if they need to be monitored
- You generally cannot triage MLK/HH transfers back out to triage...but if we are severely overcrowded (as above) It is acceptable if the attdg is ok with it
Harbor Clinic patients
- Again, generally cannot refuse patients
- if they are being admitted, and are otherwise stable (do not need monitor) then they should bypass the ED and go through patient flow coordinator
- When Urgent care closes, patient gets sent to the ED
- Again FYI the charge nurse about all incoming patients
- You generally cannot triage transfers from Harbor clinics back out to triage...but if we are severely overcrowded (as above) It is acceptable if the attdg is ok with it. Use the .edambutriage template.
MAC transfer requests
- ED attendings only
- Often for "higher level of care"
- Patient Flow Facility must also approve transfer, typically before ED attending gets involved
- Make sure MAC discusses the patient by the specialist and admitting team, e.g. multi-trauma patient who needs NSG intervention needs to be accepted by neurosurgery AND trauma
- Applies only to ED patients (not admitted inpatients)
- TRICK: Suggest to bypass the ED if you think is clinically appropriate.