Harbor:ED follow-up options
(Redirected from Harbor: ED Follow-Up Options)
- 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.
- 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. For any questions, send the patient to Window 6 in the AWR.
- File:AED followup flowchart 8-23-21.pdf - note: using DC to specialty order, not clerk scheduling
- File:PED followup flowchart 8-23-21.pdf - note: using DC to specialty order, not clerk scheduling
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
Same/Next Day Specialty Clinic Follow up
- Sending or discharging directly to specialty clinic
- ED Extension Appointments
- Please utilize the ED to Specialty Clinic Referral Guidelines
CCC
- Bridges DHS eligible patients to primary care until empaneled
- 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
DHS eligible patients
OOP follow up options
Urgent Specialty Follow-up for DHS
- Within 4 weeks or less
- Place the "ED Request for Specialty Appointment" order (7/23/2023)
- 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.
Pediatrics CCS Follow up
MAT/BUP/Opiate Withdrawal
NERF
- This periodically changes, but there is currently limited space with the exception of Geriatrics, HIV, and OB care
Patient wants to switch to Harbor
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
Clinics not included in ED to Specialty Care Order (2023)
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
Stress Testing
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