Harbor:ED follow-up options
REFER TO
- File:AED followup flowchart 8-23-21.pdf
- File:PED followup flowchart 8-23-21.pdf
- Outpatient Follow up is based on patient’s insurance network
- Out of Plan (OOP), means the patient has Non-DHS insurance network, Private insurance, Other Medi-Cal HMOs, or could be out of County/Country.
- MHLA, MyHealthLA, are > 18yo, “uninsurable,” community clinic PCP that can e-consult to get subspecialty & inpatient care through DHS
- DHS means LA County Department of Health Services network eligible
- Patient Relations Representatives (PRR) in ED 7 days a week;
- Call Registration for PRR who can help empanel into DHS or change empanelment/network in real time. During business hours, can also send patient to Patient Relations Office in Rm 1-B-1.
Same/Next Day Specialty Clinic Follow up
- Sending or discharging directly to specialty clinic
RESULTS/SYMPTOM FOLLOW-UP
- OOP, MHLA, DHS can all have phone follow up for results (labs or imaging), symptoms checks
- Adults results/symptom phone follow up (Lab Follow-up - HAR)
- Peds results/symptom phone follow up (Peds - HAR/USC)
- Follow-up of outpatient labs/imaging
- Any imaging/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
OOP follow up options
DHS eligible patients
Urgent Specialty Follow-up for DHS or MHLA Patients
- Within 4 weeks or less
- Place the "ED Request for Specialty Appointment" order
- As of 7/25/23, no longer done by clerks
- If no approval is needed per the ED to Specialty Clinic Referral Guidance document, write your name (ordering provider) in the approving provider field.
- When specialty approval is required per the document, place the approving specialty provider’s name in the field.
- After a conversation with a consulting specialist, their specific recommendation supersedes any timeframe listed in the ED to Specialty Clinic Referral Guidance document.
NERF
Patient wants to switch to Harbor
Instructions for clerk requesting/booking an appointment
Pediatrics CCS Follow up
CCC
- Bridges DHS eligible patients to primary care until empaneled (still need to NERF)
- Refer all DHS patients with substance use disorder (SUD) started on medication assisted treatment (MAT) to CCC for enrollment in Dr. Brown's addiction clinic
MAT/BUP/Opiate Withdrawal
Follow up In Other Clinics
For DHS eligible patients only: Clerk will book into appointment slot, or if unable, will place a request into the scheduling queue for Patient Access Center/Call Center to take over. Patients can also call PAC to schedule appointments (Rather than calling the clinic directly)
DHS Patients Lost to Follow-up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange for routine follow-up for the patient:
- HAR-OP-Anesthesiology: Pain Management-Clerical
- HAR-OP-Cardiology: Anticoagulation-Clerical
- HAR-OP-Cardiology: General Cardiology-Clerical
- HAR-OP-Cardiology: HFDMP-Clerical
- HAR-OP-Cardiology: Pulmonary Hypertension-Clerical
- HAR-OP-Dermatology-Clerical
- HAR-OP-Endocrine: Diabetes-Clerical
- HAR-OP-Endocrine: General-Clerical
- HAR-OP-Endocrine: Pituitary-Clerical
- HAR-OP-Endocrine: Thyroid-Clerical
- HAR-OP-Endocrinology: Diabetes Specialty-Clerical
- HAR-OP-Endocrinology: General Endocrinology-Clerical
- HAR-OP-Gastroenterology-Clerical
- HAR-OP-Hematology/Oncology-Clerical
- HAR-OP-Infectious Disease-Clerical
- HAR-OP-Neurology-Clerical
- HAR-OP-OB/Gyn: Gyn Oncology-Clerical
- HAR-OP-OB/Gyn: Gyn Urgent Care-Clerical
- HAR-OP-OB/Gyn: Reproductive Endo/Infertility-Clerical
- HAR-OP-OB/Gyn: UroGyn-Clerical
- HAR-OP-OB/Gyn: Women's Health-Clerical
- HAR-OP-Pulmonology-Clerical
- HAR-OP-Renal: General Nephrology-Clerical
- HAR-OP-Renal: Renal Hypertension-Clerical
- HAR-OP-Renal: Renal Transplant - Clerical
- HAR-OP-Rheumatology-Clerical
- HAR-OP-Surgery: Bariatric Surgery-Clerical
- HAR-OP-Surgery: Breast Surgery-Clerical
- HAR-OP-Surgery: Cardiothoracic Surgery-Clerical
- HAR-OP-Surgery: Colorectal Surgery-Clerical
- HAR-OP-Surgery: Dentistry-Clerical
- HAR-OP-Surgery: Neurosurgery-Clerical
- HAR-OP-Surgery: Ophthalmology-Clerical
- HAR-OP-Surgery: Oral and Maxillofacial Surgery-Clerical
- HAR-OP-Surgery: Orthopedic Surgery-Clerical
- HAR-OP-Surgery: Otolaryngology-Clerical
- HAR-OP-Surgery: Plastic Surgery-Clerical
- HAR-OP-Surgery: Surgical Oncology-Clerical
- HAR-OP-Surgery: Trauma Surgery-Clerical
- HAR-OP-Surgery: Urology-Clerical
- HAR-OP-Surgery: Vascular Surgery-Clerical
- HAR-OP-Pediatrics: Allergy/Asthma-Clerical
- HAR-OP-Pediatrics : Cardiology - Clerical
- HAR-OP-Pediatrics : Child Development - Clerical
- HAR-OP-Pediatrics : Craniofacial - Clerical
- HAR-OP-Pediatrics : Diabetes - Clerical
- HAR-OP-Pediatrics : Endocrinology - Clerical
- HAR-OP-Pediatrics : Failure to Thrive - Clerical
- HAR-OP-Pediatrics : Gastroenterology - Clerical
- HAR-OP-Pediatrics : Hematology - Clerical
- HAR-OP-Pediatrics : High Risk Infant - Clerical
- HAR-OP-Pediatrics : Immunology - Clerical
- HAR-OP-Pediatrics : Infectious Disease - Clerical
- HAR-OP-Pediatrics : Medical Genetics - Clerical
- HAR-OP-Pediatrics : Nephrology - Clerical
- HAR-OP-Pediatrics : Neurology - Clerical
- HAR-OP-Pediatrics : Nursery - Clerical
- HAR-OP-Pediatrics : Oncology - Clerical
- HAR-OP-Pediatrics : Rheumatology - Clerical
- HAR-OP-Pediatrics : Surgery - Clerical
Anticoagulation (Coumadin) Clinic
- ED Request for Specialty Appointment: ANTICOAGULATION (Return)
- Book without consultant approval
- Patient must be an established patient in the anticoagulation clinic seen in the last 12 months
- Request the specific date for 7 days post initiation of anticoagulation
- M-F 8am-4pm Ext. 5159, M-F after hours 4-9pm pager 9995, Sat-Sun 8am-8pm Pager 9995
Breast Diagnostic Center (Radiology)
- BDC is a Radiology Imaging Center for mammograms and ultrasounds. NOT the same as Breast Surgery Clinic
- Breast Abscess - needing ultrasound guided needle aspiration as per https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis
- Breast Mass - need imaging and biopsy of mass/malignancy as per https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Breast_mass.2Fmalignancy
Breast Surgery Clinic
- Please consult the appropriate surgical service on any patient presenting to the ED within the 30-day post-operative period, even if for something seemingly unrelated to the surgery.
- During the daytime (7a-7p), you should always directly call Breast/Surg Onc (x9397)
- After hours (7p – 7a), these teams are covered by trauma.
- If you inadvertently call trauma for these services during the daytime, they have been instructed to have you directly page the appropriate service.
- e-Consult via PCP
- If the patient needs urgent follow-up <2 weeks for DHS patient, consider consult to breast surgery resident (through Trauma surgery) from the ED
- Only for Breast Abscess in DHS patients s/p bedside I&D, recurrent breast abscess/mastitis, as per https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis
- Only for Breast Mass in DHS patient with imaging and tissue biopsy results already done https://www.wikem.org/wiki/Harbor:Operations_manual#Breast_mass.2Fmalignancy
- Otherwise, they need referral to the Breast Diagnostic Center (BDC) first for imaging
- Patients with metastatic disease - consult (Medical) Oncology from the ED
- If the patient was previously followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Breast Surgery-Clerical
BURN CENTER CLINIC
- For DHS eligible patients that need Burn Center follow up at LAC+USC, please call over 24/7 to their Burn Unit Front Desk 323-409-7991 to get an appointment w/in 2-5d depending on your assessment of their acuity.
- Inform the clerk there that you’d like to book a patient into the Burn Eval and Treatment area, which is in 5D in the Inpatient Tower (NOT their A5D Clinic).
- Patients can also call if they have questions about their appointment logistics or want to change their appointment time.
- This is NOT a transfer, so you should NOT call MAC to make an appointment
- For OOP patients, they can go to Torrance Memorial
CARDIOLOGY
- Daytime: Talk to CORE during the day, Afterhours: Talk to C-team Night fellow (listed on MedHub)
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up. (Cards will message Mariedel Morales and Sheila Walters IC, the Cardiology clerks, to book).
- For ZioPatch (holter monitor) - message empaneled PCP or CCC for cardiology
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Cardiology: Anticoagulation-Clerical
- HAR-OP-Cardiology: General Cardiology-Clerical
- HAR-OP-Cardiology: HFDMP-Clerical
Stress Testing
COLORECTAL Surgery (CRS)
- Please consult the appropriate surgical service on any patient presenting to the ED within the 30-day post-operative period, even if for something seemingly unrelated to the surgery.
- During the daytime (7a-7p), you should always directly call CRS (x0044)
- After hours (7p – 7a), these teams are covered by trauma.
- If you inadvertently call trauma for these services during the daytime, they have been instructed to have you directly page the appropriate service.
- Coming Soon: ED Request for Specialty Appointment order in Orchid
- ONLY if proven colorectal cancer; if unproven cancer, use CCC for EWC
- Book <2 weeks: HAR Colorectal Surgery New (ok to overbook)
- Any other colorectal (non-malignancy) issues, book <4 weeks
- ONLY if proven colorectal cancer; if unproven cancer, use CCC for EWC
DERM
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Dermatology-Clerical
ENT
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Otolaryngology-Clerical
Expedited Work-up Clinic (EWC)
GYN
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-OB/Gyn: Gyn Oncology-Clerical
- HAR-OP-OB/Gyn: Gyn Urgent Care-Clerical
- HAR-OP-OB/Gyn: Reproductive Endo/Infertility-Clerical
- HAR-OP-OB/Gyn: UroGyn-Clerical
- HAR-OP-OB/Gyn: Women's Health-Clerical
Gyn UCC
- Book without consultant approval
- 3-4d f/up for ALL DHS PID patients (cervical motion tenderness or adnexal tenderness, empirically treated)
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-OB/Gyn: Gyn Urgent Care-Clerical
Interventional Radiology
Limb Salvage
- Opting out of automatic 30-day automatic f/up consult
- Weekdays 7a - 5p
- If the patient seems stable for outpatient follow-up:
- Page limb salvage p0847
- After discussion with on-call resident/NP, initiate a TEAMS Chat with: ED attending, ED resident, LS on-call res/NP, LS on-call Attending and send a picture of the involved foot
- The limb salvage team may respond with appropriate outpatient f/up timeframe or may notify you they will come see the patient in the ED if they feel it is necessary
- If the patient seems stable for outpatient follow-up:
- Afterhours (5p - 7a weekdays, weekends, holidays)
- Consult trauma if the patient needs surgical evaluation; trauma will liaise with limb salvage attending
- Do NOT consult surgery for appointment
- For appointment only, can directly contact limb salvage OR defer to PCP for e-consult to podiatry (at MLK) if appropriate (several weeks to f/up)
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- Clerk books directly into HAR Surg VASC -> Podiatry New
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- Consult trauma if the patient needs surgical evaluation; trauma will liaise with limb salvage attending
A. Wu, MD - ED Director of Ops & A. Miller, DPM - Director of Limb Salvage, Co-Chair of DHS Podiatry Workgroup 3/30/22
Nephrology Clinic
- For non-dialysis patients only: Don’t need Nephrology fellow approval per Sharon Adler, MD, Chief, Division of Nephrology and Hypertension, 7/28/17)
- 3 slots a week specifically earmarked for ED use for Thursday morning Nephrology clinic (GN, diabetes, other CKD)
- 2 “Discharge” slots for the Friday afternoon Hypertension (complex/resistant HTN, HTN with CKD, stones, PCKD, SLE)
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Renal: General Nephrology-Clerical
- HAR-OP-Renal: Renal Hypertension-Clerical
- HAR-OP-Renal: Renal Transplant - Clerical
Neurosurgery
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Neurosurgery-Clerical
OB
- For new desired pregnancy w/out anticipated complications: discharge patient with OB clinic intake phone number (424-306-7200) so they can schedule appointment. OB intake is a medical assistant appt, NOT a provider
- For patients with needing serial beta HCGs, patient should follow with Gyn UCC w/in 2-4 days
- For patients considering pregnancy termination or interested in discussing options: discharge patient with general Gyn clinic phone number (424-306-4061), they can request appointment with ROC (reproductive options clinic)
ONCOLOGY
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up.
- Newly diagnosed, metastatic cancer - discuss with oncology fellow p7862
OPHTHO
- Book without consultant approval for next day follow up for orbital wall fractures w/o orbital injury concerns, ok per Dr. Prasad, Division Chief
- All other cases: Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Ophthalmology-Clerical
- Ophtho Alphabet soup:
AAU: acute anterior uveitis AFT: artificial tears AGV: Ahmed glaucoma valve ARMD or AMD: age-related macular degeneration DR: diabetic retinopathy BRAO: branch retinal artery occlusion BRVO: branch retinal vein occlusion BULB: bilateral upper lid blepharoplasty BVS: borderline visually significant C/D: cup-to-disc ratio CEIOL: cataract extraction with insertion of intraocular lens CME: cystoid macular edema CRAO: central retinal artery occlusion CRVO: central retinal vein occlusion CSME: clinically significant macular edema CS: cortical spoking (cataract) CSR: central serous retinopathy DES: dry eye syndrome DME: diabetic macular edema DWC: dense white cataract ED: epithelial defect EL: endolaser ERM: epiretinal membrane FML: focal macular laser GS: glaucoma suspect HST: horseshoe tear HVF: Humphrey visual field K: cornea LH/WC/AFTs: lid hygiene, warm compresses, artificial tears LPI: laser peripheral iridotomy MMCR: Muller's muscle conjunctival resection MP: membrane peel NCVH: non-clearing vitreous hemorrhage NPDR: non-proliferative diabetic retinopathy NS: nuclear sclerosis (cataract) NTG: normal tension glaucoma NVG: neovascular glaucoma NVS: not visually significant OD: right eye OHTN: ocular hypertension OS: left eye OU: both eyes POAG: primary open angle glaucoma PCO: posterior capsular opacity (aka, secondary cataract) PDR: proliferative diabetic retinopathy PKP: penetrating keratoplasty (aka corneal transplant) PPV: pars plana vitrectomy PRP: pan retinal photocoagulation PSC: posterior subcapsular cataract PTG: pterygium PVD: posterior vitreous detachment RRD: rhegmatogenous retinal detachment RT: retinal tear SB: scleral buckle SRD: serous retinal detachment Trab: trabeculectomy TRD: tractional retinal detachment VA: visual acuity VH: vitreous hemorrhage VS: visually significant XT: exotropia YAG cap: YAG capsulotomy
ORTHO
- Starts 5/1/23
- Make sure you're signed off on splinting Splinting Guide with Videos
- File:Ortho consult criteria_Harbor_Final.pdf
- Book: depends on injury, see below, with or without consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Orthopedic Surgery-Clerical
- Diagnoses Where Orthopedics SHOULD Be Consulted While Patient is in the ED
- Consult after XR or other appropriate workup is complete. A single scout film may be the appropriate initial imaging for polytrauma patients with obvious open fracture.
- Incarcerated or non-DHS patients with a diagnosis not found on the “refer to primary care list” may benefit from an orthopedic consult (call orthopedics to review if unsure) to optimize their pre-discharge care and specify timeframe for f/up
- Always ask/consult if unsure!
- General:
- Acute hardware infection
- Amputation (including subtotal amputation with dysvascular distal part)
- Chronic osteomyelitis (not related to diabetic foot infection [admission guideline])
- Compartment syndrome in extremity with fracture
- Crush injury to the extremity (other than distal tuft)
- Irreducible fracture or dislocation
- Laceration or fracture with tendinous or neurovascular injury or symptoms
- Open fracture of an extremity or impending open fracture (eg, a fracture resulting in skin tenting)
- Open joint, acute foreign body in joint (consult ortho prior to challenge when high suspicion)
- Septic joint (ED to perform arthrocentesis outside region of erythema/cellulitis and consult if results are concerning for infection or if unable to aspirate)
- Any pediatric fractures requiring procedural sedation or surgery
- Clavicle
- Clavicle fracture with >5mm displacement
- AC joint dislocations, types 4-6
- Arm/forearm
- Proximal humerus fracture with displacement
- Humeral shaft fracture with displacement
- Any displaced elbow fracture (radial head/neck, distal humerus, olecranon, coronoid)
- Radius, Ulna, or both bone forearm fracture
- Distal radius fracture with displacement
- Wrist/Hand
- Scaphoid fracture with displacement
- Acute lunate or perilunate dislocation
- Flexor tenosynovitis
- Flexor tendon (palmar hand) injuries
- Metacarpal fractures with angulation or malrotation or involving multiple MCs
- Any clenched fist injury, (aka: fight bite)
- Pressure injection injuries
- Hand/finger abscesses (excluding paronychia and felon)
- Reduced DIP/PIP/MCP/CMC dislocations
- Displaced Phalangeal fractures (other than distal tuft)
- Nailbed injury with underlying distal phalanx fracture aka Seymour fracture (excluding tuft)
- Pelvis/thigh/knee
- Any pelvic fracture
- All hip and knee dislocations
- Any femur fracture
- Patella fractures
- Acute patellar or quadriceps tendon rupture
- Multi-ligamentous knee injury (i.e. dislocated knee s/p spontaneous relocation)
- Leg/ankle
- Any tibial plateau fracture (please discuss case with ortho prior to ordering any CT)
- Any tibial shaft fracture
- Pilon (distal tibia articular impaction) fractures
- Ankle fractures with displacement (call orthopedics to review XR if unsure)
- Foot
- Calcaneus fractures
- Talus fractures
- Subtalar dislocations
- Lisfranc injuries (including 1st and 2nd metatarsal base fractures)
- Navicular / Cuboid / Cuneiform fractures
- General:
- Diagnoses which can be stabilized by ED and REFERRED TO ORTHO Fracture Clinic in 2 weeks unless otherwise specified
- Establishing follow up after outside hospital orthopedic procedure
- Any fracture with radiographic healing (eg, callus formation)
- Chronic foreign body in joint
- Fractured non-unions or malunions
- Symptomatic orthopedic hardware
- Shoulder/arm
- Isolated scapular body fracture
- Non-displaced/minimally displaced (<5mm midshaft clavicle fracture)
- AC joint dislocation, types 1-3 (DESCRIBE TYPES 1,2,3)
- Rotator cuff tear confirmed on MRI (Ortho Sports Clinic, NOT fracture clinic)
- Nondisplaced proximal humerus fracture (DEGREE OF ANGULATION - sling vs sarmiento?)
- Elbow/forearm
- Elbow and shoulder dislocations with no associated fracture that have appropriate imaging confirming reduction** (perfect lateral for the elbow, axillary, Velpeau, or CT for the shoulder). call orthopedics to review XR if unsure
- Nondisplaced Radial head/neck fracture (splint then Ortho Fracture Clinic - WHY IS THIS LISTED - WHOLE SECTION TO FX CLINIC)
- Nondisplaced distal radius fracture (splint then Ortho Hand Clinic, NOT Fracture Clinic)
- Wrist/Hand
- Occult scaphoid fracture (Ortho Hand clinic, NOT Ortho Fracture Clinic)
- Non-displaced phalangeal and metacarpal fracture (intrinsic plus splint then refer to clinic; boxer's fractures ok to put into soft dressing then refer to hand clinic - BUDDY TAPE?)
- Extensor tendon (dorsal hand) injuries (splint then refer to Ortho Hand Clinic in <7 days, NOT Ortho Fracture Clinic)
- Distal phalanx fracture without nailbed injury (excluding tuft - Ortho Hand clinic, NOT Ortho Fracture Clinic)
- Distal phalanx fracture with subungual hematoma (Ortho Hand Clinic, NOT Ortho Fracture Clinic)
- Nailbed injury WITH tuft fracture or without underlying distal phalanx fracture, after ED repair (Ortho Hand Clinic, NOT Ortho Fracture Clinic) ABX IF OPEN?
- Lower extremity
- Patellar dislocation s/p relocation (if DHS Empaneled --> Ortho Sports Clinic)
- Single knee ligament injuries (eg, isolated ACL rupture, meniscal injuries confirmed on outpt MRI - ED MRI not indicated; if DHS Empaneled --> Ortho Sports Clinic)
- Ankle fractures without displacement subluxation or dislocation (call orthopedics to review XR if unsure)
- Achilles tendon rupture
- Fracture of 1st-5th metatarsal shafts
- Diagnoses which can be stabilized by ED and REFERRED TO ORTHO Fracture Clinic in 2 weeks unless otherwise specified
- Diagnoses which can be stabilized by ED and referred to Primary Care (NO ORTHO CONSULT NEEDED)
- Arthritis (osteoarthritis of knee or hip OR inflammatory arthritis [consider rheumatology referral])
- Cellulitis
- Chronic pain
- Toes:
- Closed minimally displaced distal phalanx fracture can be treated with buddy tape & hard sole shoe
- Closed fractures of the lesser (2nd-5th) toe phalanges
- Deep foreign body in extremity without neurovascular symptoms, fracture, or joint involvement
- Gunshot wound to extremity without fracture, tendinous, or neurovascular injury (DHS-empaneled patients may be referred to Ortho Joint Reconstruction Clinic)
- Shoulder impingement
- Sprains, strains, or contusions (no fracture or joint space widening on radiographs)
- Tendonitis
- Diagnoses which can be stabilized by ED and referred to Primary Care (NO ORTHO CONSULT NEEDED)
PEDIATRIC ORTHO
- Orthopedic conditions that can be managed in the ED with Orthopedic follow-up (must be neurovascular intact; ED clerk can book into orthopedic fracture clinic):
- Radius, ulna, fibula, clavicle, tibia fractures
- < 5mm displaced and < 15 degrees angulation
- Pain controlled by oral meds
- Normal neurovascular status
- 5 years and older
- Proximal humerus fractures with minimal displacement – place in sling
- Elbow trauma with elevated posterior fat pad, no visible fracture
- Foreign bodies not in bone or joint space
- Salter Harris 1 fractures that are not displaced
- Distal phalanx fractures not involving joint space
- Tuft fractures
- Radius, ulna, fibula, clavicle, tibia fractures
- Peds Specifics
- OK to Splint; DHS Eligible
- Call ortho and ask for approval to book in clinic the next Tuesday for Pediatric fracture clinic.
- Ortho does not have to see the patient or write a consultation
- OK to splint; OOP (these will not qualify for CCS)
- D/c patient with copies of films
- Specific instructions to family to call and get ortho referral
- Hand-out available with options for families (PMD, Shriner’s, Orthopedic institute)
- Patients Seen at OH splinted and referred to Harbor; Call ortho if:
- DHS eligible or empaneled
- Believe urgent/emergent intervention needed
- Needs a reduction
- Patient having difficulty getting into empaneled orthopedist (can give hand-out of other options).
- Ortho attempts to get CCS and if not able helps get care
- Ortho and CCS (California Children’s Services)
- Ortho has hired Anna Contreras ( Daisy) to help get CCS for many of the OOP ortho patients
- If patient is OOP and ortho requests to see them after they splint or cast send a communication to Anna Contreras through Cerner and she gets back to families within 1 business day.
- Instructions on each computer in PED doc box
- If the patient doesn’t qualify for CCS, they will help the family get into their orthopedist
- Ortho and CCS (California Children’s Services)
- Ortho attempts to get CCS and if not able helps get care
- OK to Splint; DHS Eligible
PEDIATRICS
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Pediatrics: Allergy/Asthma-Clerical
- HAR-OP-Pediatrics : Cardiology - Clerical
- HAR-OP-Pediatrics : Child Development - Clerical
- HAR-OP-Pediatrics : Craniofacial - Clerical
- HAR-OP-Pediatrics : Diabetes - Clerical
- HAR-OP-Pediatrics : Endocrinology - Clerical
- HAR-OP-Pediatrics : Failure to Thrive - Clerical
- HAR-OP-Pediatrics : Gastroenterology - Clerical
- HAR-OP-Pediatrics : Hematology - Clerical
- HAR-OP-Pediatrics : High Risk Infant - Clerical
- HAR-OP-Pediatrics : Immunology - Clerical
- HAR-OP-Pediatrics : Infectious Disease - Clerical
- HAR-OP-Pediatrics : Medical Genetics - Clerical
- HAR-OP-Pediatrics : Nephrology - Clerical
- HAR-OP-Pediatrics : Neurology - Clerical
- HAR-OP-Pediatrics : Nursery - Clerical
- HAR-OP-Pediatrics : Oncology - Clerical
- HAR-OP-Pediatrics : Rheumatology - Clerical
- HAR-OP-Pediatrics : Surgery - Clerical
Pediatric Adolescent Clinic
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
Pediatric Cardiology
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Pediatrics : Cardiology - Clerical
PLASTIC SURGERY
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Plastic Surgery-Clerical
PULMONARY
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
PROCEDURE CLINIC
- For patient needing recurrent paracentesis
- From Dr. Anshu Abhat:
- only available for patients who are empaneled to Harbor-UCLA Internal Medicine or Geriatrics clinic.
- If an ED provider thinks a patient could benefit from procedure clinic, they should include this in the ER note/documentation (ideal) or message the empaneled provider. Referrals to procedure clinic should only come from PCP's (not from ER providers).
RHEUM
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Rheumatology-Clerical
STI Testing
- HAR Positive Care Clinic
- DHS empaneled patients only 18 y/o and above with high-risk behavior (multiple partners, recurrent STI, etc)
- M-F 8a-4:40p
- x64350 to schedule appt
- can Orchid message Claudia Murray, RN and Vanessa Salguero (clerk) after hours; include reason for referral (eg: “referral for HIV/STI testing in a patient with multiple partners”)
- PrEP - Orchid message Tiffany Hogan (navigator)
- Offers:
- HIV/STI testing
- HIV Pre Exposure Prophylaxis (PrEP)
SURGERY
- Please consult the appropriate surgical service on any patient presenting to the ED within the 30-day post-operative period, even if for something seemingly unrelated to the surgery.
- During the daytime (7a-7p), you should always directly call CRS (x0044), Bariatric/MIS (x0802), Pediatric (x6105), Breast/Surg Onc (x9397), and Vascular (x0503 – note the new pager number).
- After hours (7p – 7a), these teams are covered by trauma.
- If you inadvertently call trauma for these services during the daytime, they have been instructed to have you directly page the appropriate service.
- Book: with consultant approval - write name of approving doctor, time frame, and reason for follow up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Bariatric Surgery-Clerical
- HAR-OP-Surgery: Cardiothoracic Surgery-Clerical
- HAR-OP-Surgery: Colorectal Surgery-Clerical
- HAR-OP-Surgery: Plastic Surgery-Clerical
- HAR-OP-Surgery: Surgical Oncology-Clerical
- HAR-OP-Surgery: Trauma Surgery-Clerical
- HAR-OP-Surgery: Vascular Surgery-Clerical
UROLOGY
- Nephrolithiasis
- OK for clerk to book per Dr. Blumberg within 7-10d without calling urology consultant if meet below criteria
- New Dx Nephrolithiasis
- BMP, UA, consider CT for size/location/hydro (US if pregnant), have patients strain urine
- Established Nephrolithiasis
- BMP, UA, bedside US for hydro
- New Dx Nephrolithiasis
- OK for clerk to book per Dr. Blumberg within 7-10d without calling urology consultant if meet below criteria
- CALL urology consult for patients with UTI (infected stone), h/o DM, solitary kidney, pregnancy
- PCP follow-up if not already established, then can NERF when appropriate.
- PCP for non-obstructive <5mm stones
- Ureteral stent or percutaneous nephrostomy tube pain without concern for infection, otherwise uncomplicated course, follow-up in urology clinic in 7 days
- Send Urine culture
- Acute urinary retention
- OK to book in Urology Clinic in 10-14 days WITHOUT consult approval per Dr. Blumberg if near baseline Cr, no significant electrolyte derangements, no evidence of post-obstructive diuresis, pain is controlled, and tolerating PO's
- Place foley, send UA, BMP; do NOT sent PSA (falsely elevated with acute retention)
- If <200ml output, remove catheter
- If >400ml out, maintain catheter
- Monitor for post obstructive diuresis. If >200ml/hr for 2 hours (not counting the initial output), consider further observation and IVF resusc
- Discharge with tamsulosin 0.4 mg daily
- All other Urologic conditions: book with consultant approval - write name of approving doctor, time frame, and reason for follow up
- Epididymitis/orchitis just needs PCP f/up
- If the patient has previously been followed at Harbor, but was lost to follow-up, you can message the following clinic-specific message pools and they will arrange follow-up for the patient:
- HAR-OP-Surgery: Urology-Clerical
Per Dr. Blumberg (Urology) & Dr. Wu 2/8/22
FOLLOW-UP FOR OUT-OF-COUNTY/OUT-OF-COUNTRY (OOC) PATIENTS
Per DHS Policy 516.1, Out of County/Country Patients who need an urgent follow-up for an emergency medical condition may be provided such follow-up at Harbor
- Emergent Conditions:
- Places health in serious jeopardy
- Threatens serious impairment to bodily functions
- Threatens serious dysfunction to any organ or body part
- If they are from a county close by - consider referring them to their home county. Call 2-1-1 social services hotline.
- Do not arrange follow-up for NON-EMERGENT/URGENT issues
- If patient is no longer Out of Country/County, they can go to Registration Rm 108, 1st floor main hospital), ext 8101 to change their address.
Dir AED, Dir OPS, DHS Policy 516.1 9/25/17