Harbor:Main

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

Admin Updates
  • Coronavirus (COVID-19) Info
    • Visitor Policy:
      • End of life: 1 visitor at a time, 2 visitors per day, up to 4 hours total
      • ALOC/disruptive behavior: 1 visitor at discretion of clinical team
      • ICU: 1 per day, 2 hours max
      • Peds: 1 visitor/guardian
      • Consult IPC if visitor has COVID or COVID exposure
  • New Flu diagnosis and treatment algorithm for 2020-21 File:Flu Dx and Tx algorithm 2020-21 V.2 final.pdf
  • OBS Update (6/2/2020) - for patients being admitted to the new short-stay medicine team, page the ED hospitalist at 204-9753, order "PLACE IN OBS" (just like we did pre-COVID); the medicine team will order the "request for admit" once they get the COVID test results. Drs. Spiegel & Chappell

General Administrative
  • Pre-hospital
    • Incoming transfers
    • Exodus Transfers
      • Exodus should call Psych ED about transfer, not Med ED
      • Med ED will do MSE

Administrative duties
    • Administrative resident directions
    • Receiving Phone Calls
    • EKG Screening
    • Pre-shift: 5S
    • Airway Bag
      • Missing or low on equipment such as McGrath blades or batteries - inform the overall charge nurse (more in nursing office)
      • PURPLE SENIOR - use the laminated checklist to stock AT EACH SHIFT CHANGE on on-call days
      • Locks let you know which compartments to check
      • ED pharmacists help with meds BUT SENIORS should double check.
      • TURN OFF McGRATH AFTER USE!
      • Can use new “GlideScope Go” with a MAC 3 & 4 blade, but bring it back. (It’s not part of bag).

Wu 11/2019)

RME & triage

Managing your Patient

Tests & Orders
  • Labs
  • Radiology
    • StatRad
      • All studies Fri 4p-Mon 8a with expected TAT<4 hrs
      • Code Strokes after 4p daily
      • Available 24/7 as-needed
      • Reports go directly into FirstNet
      • Faxing prelim during downtime
    • Fortino
      • All X-rays M-F 8a-5p
    • Radiology resident
      • Mon – Thursday 4p - 8a
      • Prelim reads on ED CT, US, MRI
      • Call resident for any XR questions overnight (prelim read), otherwise enter an ED PRELIM and Fortino will over-read in the AM
      • For any XR or CT disagreements overnight, the ED attending can request radiology resident send to StatRad for a final attending read
        • The radiology resident will ask for your name and call-back spectralink and push the radiology study to StatRad

Enter Prelim Rads Read
  • Ultrasound
    • Ordering a Formal Ultrasound
    • Ultrasound approval list
    • Formal & ED Ultrasounds
    • Cleaning Endocavitary Probes
      • Place in Red Bag (above probe cabinet in clean utility room)
      • Place patient sticker on bag
      • Give to area charge nurse
      • Once cleaned, probe comes back in clear bag
      • T. Jang 8/2019
  • Oral contrast
    • No more gastrograffin, replaced by omnipaque. Must place an order for it. If you need to obtain a retrograde urethrogram, order a KUB.
    • Below is the suggested/usual volume of omnipaque used for certain indication sent to us by Dr. Putnam:
      • For use in bowel obstruction, a volume of 100cc of Omnipaque 300 is used.
      • For use in tube contrast studies, a volume anywhere between 50-200cc of Omnipaque 300 would likely be used.
      • For a CT with po contrast, the order is for 30cc of Omnipaque 300 in 970cc of water.


STAT MRI

Antibiogram

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

Finding Equipment/DME

Procedures

Special patient types

Others

Patient Disposition

Discharge

Empanelment
  • Primary Care Information tab in Cerner -> New Empanelment -> click any applicable special populations -> Harbor-UCLA MC as requesting facility -> enter any additional pertinent comments -> click box to get email notification once empanelment occurs -> Send NERF request
    • please let patient know they should get a call within 14 days (typically ~72 hours)
  • CCC for specialist
  • 1B1
  • PAC (Patient Access Center) x64400

ED Follow-Up Clinics
  • Follow-up of out patient labs/imaging
    • Any imaging or 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 (Peterson 11/19)

Transportation Needs
  • BUS/METRO TAP CARDS:
    • 8a-5p - send to Social Work Office
    • nights/weekends/holidays - ED RN can get from the House Supervisor x65620 or spectra 23721 who will deliver the voucher to the ED
  • TAXI VOUCHERS: Must have a place to go with keys/someone home, or a shelter where patient is already accepted
    • Daytime - call Social Work to facilitate
    • Night/Weekend/Holidays - call house supervisor x65620 or spectra 23721 who will deliver the voucher to the ED
      • RN calls taxi - must notify taxi if needs wheelchair accessibility (Yellow Cab @ 310-533-6800)
      • RN takes the patient to the hospital nursing office; taxi driver comes to nursing office to sign paperwork and pick up the patient
  • UBER/LYFT:
    • Similar to above Taxi Vouchers
    • Available to patient's without insurance who do not have other transportation options
  • AMBULANCE: for patients that have a medical necessity (cannot ambulate, here w/o wheel chair, etc) and medically cannot take a taxi
  • ED RN & area clerk to coordinate with insurance (if applicable)
  • If patient is UNINSURED (including restricted Medi-cal) - use county transport to get an ambulance home
    • UR & SW can get involved if issues
    • If patient lives outside of LA County, call nursing supervisor or SW as they may need further authorization
      • Joy Lagrone can authorize county transport as a last resort
  • kids without car seats: For kids who arrive (usually by ambulance) w/o a car seat, we do not have car seats available. however, options are:
  1. take the bus home (no need for car seat)
  2. have someone bring a car seat and pick them up or go home in a taxi with the car seat that is brought
  3. if a. or b. will not work, can try arranging for ambulance (see section above)

Social EM resources
  • Harbor Social Work
    • 24/7 Auto page in house social worker p1735 for various issues including: homelessness, discharge planning, sexual assault, crisis/grief, suspected elder/child abuse, recoup care, disability benefits (SSI), etc.
  • Homeless Task Force, in person during business hours 730a-4p Mon-Fri pager # is (310) 501-0637 and their phone number is (310) 413-8871
  • Opiate Withdrawal/MAT/BUP
  • Medical Legal Partnership
  • Immigration Assistance
  • Hospital Based Violence Intervention Program and Trauma Recovery Center
  • Whole Person Care (WPC) autopage in Cerner, p0145, refer 24/7.
    • Substance use disorders (SUD)
      • Available SUD counselor in person Mon 8a-5p, T-F 8a-1230a, Sat 4p-1230a.
      • Otherwise will follow up next business day via phone call. Need good contact phone number. Ensure patient knows you put a referral and someone will be contacting them.
      • On discharge, include the WPC discharge instructions (“Whole Person Care Harbor-UCLA”, also available in Spanish) from ORCHID
    • Medically Complex Transitions of care (includes 3 visits to ED in past year)
      • 1) ORCHID Message/Call/Text Lelalee Vicedo - Social Work Supervisor. Please include MRN, pt phone number, and reason for referral. (213) 572-9895. She will respond M-F 9:00-4:30 pm but you can ORCHID message/call/text/email anytime.
      • AND 2) place order in ORCHID: Consult to Social Work: reason for referral = other, free text WPC TOC
  • Re-entry (released from prison <6 months with medical, mental health, substance abuse, or social needs) 844.804.5200 (24/7) and put patient on phone.
  • Food Pharmacy, free fruits and vegetables every Wednesday 9a-1p outside front entrance of S/E building
  • Free cell phones:
    • Lifeline free phones: Outside of S/E building 8a-6p (Monday - Sat)
    • Social work has a limited number
  • Mental Health
    • Residential & Bridging Care (transition from mental health institution to community) 213.738.4775
    • Intensive Service Recipients (mental health with 2 or more admissions in year, recent DC from psych hospital) 844.804.5200
  • Perinatal (high-risk pregnant mothers - homeless, mental health, substance abuse, domestic violence, no food) Mama's Program844.376.2627

Admission Guidelines

Right level of care

OBS & CORE
  • Observation placement
  • CORE placement
  • Observation Patients Direct from UCC
    • Do not need an ED MSE - can go direct to OBS
    • If no OBS beds available in GOLD - should be made Direct Admits to the Hospital

Peterson 8/2019

Other Disposition

Documentation

Disaster & Surge

Resident Education

See Also

Special:Prefixindex/Harbor

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