View source for SCVMC:ED

''Santa Clara Valley Medical Center: Emergency Department''

==Administrative==
*'''Accepting transfers'''
**"[https://www.wikem.org/w/images/Trauma_Activation_Criteria.pdf Red Box Trauma]" - accept all
**Pediatric Ortho from Regional Medical Center - accept
**STEMI from SLH - transferring physician speaks to interventional cardiologist first
**Valley Health Plan - transferring physician speaks with transfer line
**Other Transfers - transferring physician need specialty accepting physician, not ED
*[[SCVMC:Phone List | Department Phone List & Door Codes]]
*[https://www.wikem.org/w/images/QI_case_rating_form.pdf QI Case Review Form]

==Patient Care==
===General===
*[[SCVMC:Dot Phrases | Departmental Dot Phrases]]
*'''Chest Pain''': [https://www.wikem.org/w/images/SCVMC_Chest_Pain_Algorithm.pdf HS-Troponin Chest Pain Algorithm]
**Outpatient Stress Test: call Gold hospitalist to coordinate
*'''Stroke''': [https://www.wikem.org/w/images/Strokealertandextendedstroke.pdf (Extended) Stroke Criteria] pg. 4-5
*'''Sepsis''': [https://www.wikem.org/w/images/VEP_SEP-1_Compliance.pdf SEP-1 Sepsis Core Measures]
**[https://www.wikem.org/w/images/SCVMC_Adult_Antibiogram_2019.pdf Adult Antibiogram 2019] | [https://www.wikem.org/w/images/SCVMC_Pediatric_Antibiogram_2019.pdf Pediatric Antibiogram 2019]
***[https://hhsconnect.sccgov.org/sites/vmc/pharmacy/Pages/antimicrobial.aspx VMC Antimicrobial Stewardship Webpage]
*'''COVID-19''': [https://docs.google.com/document/d/10Dv_fwZK6JYFibRIrnBRxBeQIcn64Tnu0z5SpFMC6ic/edit COVID-19 VEP Guidance]
*'''Protocol advanced imaging''' with radiology (x57625) for:
**CT scans with IV contrast
**MRI
**Ultrasound - Friday 10pm - Sunday 10pm & holidays
*[https://www.wikem.org/w/images/Ordering_Equipment_from_Pacific_Medical.pdf Ordering and Fitting (DME) Durable Medical Equipment From ED]: Pacific Medical (available 24/7)
**[https://wikem.org/w/images/DME_Order_Tip_Sheet.pdf Using on-site stocked DME]
*[https://www.bridgetotreatment.org/resources Suboxone Induction Protocol (CA Bridge)] | [https://www.wikem.org/w/images/Opioid_%26_MAT_Algorithm.pdf SCVMC Algorithm]
**Business Hours Process:
***Induce patient per protocol
***Contact Jill Lassettre, our Substance Use Navigator (SUN), 669-236-1564
****She will arrange followup care with Substance Use Treatment Services (SUTS)
**After Hours Process:
***Induce patient per protocol
***Fill out a Treatment Appointment Form 
****Located on a clipboard hanging on the wall by the nursing stations in RME or XC
****Every business day, an 8am appointment at the Central Valley Clinic (CVC) is kept open for ED-induced patients
***Send Jill Lassettre a message via EMR with MRN and expected appointment date
** [https://www.wikem.org/w/images/COVID-19_ED_Bridge_Follow_Up_Note.pdf COVID-19 Clinic Follow-Up Note]
**[https://www.wikem.org/w/images/Bup_home_Initiation.pdf Buprenorphine Home Induction]
**[https://pcssnow.org/medication-assisted-treatment/ Free Online DEA-X Waiver Training] (Cat 1 CME: MD 8hr, PA 24hr) is available
*[https://hhsconnect.sccgov.org/sites/vmc/infection/Pages/exposure.aspx Occupational Exposure of HHS Healthcare Workers]
**M-F 8AM-430PM: Refer to Employee Health 408-793-2658 - 751 S. Bascom Avenue, Suite 160 (Valley Specialty Center)
**After hours: ED/EXC evaluation
***Exposed employee should notify their supervisor regarding source patient. Source patient's attending to order [https://hhsconnect.sccgov.org/sites/vmc/infection/Documents/3-Exposure%20Source%20Patient%20Follow-Up.pdf source testing panel]
***Do not order tests on exposed employee.
***Have patient fill out [https://hhsconnect.sccgov.org/sites/vmc/infection/Documents/6-Post%20exposure%20form%20fax%20to%20Employee%20Health.pdf Post-Exposure Form]. Fax one copy, give another copy to exposed employee
***Determine [https://hhsconnect.sccgov.org/sites/vmc/infection/Documents/5-Post-Exposure%20Prophylaxis%20PEP%20Consent%20Form.pdf HIV PEP] need:
****If source patient is HIV negative: no HIV PEP needed.
****If source patient is HIV positive: highly recommend HIV PEP
****If source patient HIV status unknown: per [https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm CDC] reasonable to provide HIV PEP until source testing is confirmed, give patient HIV PEP first dose in ED and prescribe enough until Employee Health follow up date
***Exposed employee follows up next business day at Employee Health
*[https://www.wikem.org/w/images/PrEP_and_PEP.pdf PrEP and PEP Valley PACE Clinic Info]
**[https://www.cdc.gov/stophivtogether/library/prescribe-hiv-prevention/brochures/cdc-lsht-php-brochure-prep-faq.pdf PrEP]: CDC FAQs
**[https://www.wikem.org/w/images/PEP.pdf PEP]: Valley Non-Occupational Exposure

===Interdepartmental: Admissions & Consultations===
*[https://www.wikem.org/w/images/SCVMC_ED_Admission_Grid_Guidelines.pdf ED Admission Grid Guidelines & Femur Fracture Protocol]
**'''Hand [https://www.wikem.org/w/images/Hand_Trauma_Algorithm.pdf Algorithm]''': Ortho (odd days), Plastics (even days)
**'''Face''': Otolaryngology (odd days), Plastics (even days)
**'''Reimplant/Revascularization''': Stanford
**'''Type A Thoracic Dissection''': Stanford (typically)
**'''Pediatric Neurosurgery''': Lucile Packard Children's Hospital
**'''Breast''': General Surgery
**'''SICU''': speak with Trauma Attending
**'''CCU''': speak with Cardiology Attending
**'''MICU''': speak with MICU Resident

*Contacting Consultants
**'''STEMI''': MUC to page
**'''Stroke''': MUC to page
**'''Trauma Activation''' [https://www.wikem.org/w/images/Trauma_Activation_Criteria.pdf (Criteria)]: MUC to page
***All hospital admissions with a traumatic injury (unless isolated ortho) require a trauma attending consult
**'''Emergent Consult''': MUC to page
**'''Anesthesia''': Use AMION to call phone
**'''All other consults''': [https://www.wikem.org/w/images/Epic_Secure_Chat.pdf Use Secure Chat]

*[https://www.wikem.org/w/images/Overnight_NSGY_Consult.jpg Criteria to defer NSGY consultation in traumatic injury overnight]

*[https://www.wikem.org/w/images/Transfer_ED_to_BOUC_after_MSE_%281%29.pdf OBGYN MSE to BOUC Clinic Workflow (M-F 830-1600)]
**[https://www.wikem.org/w/images/Pregnant_Patients.pdf Valley New Pregnancy Algorithm]

*'''Kaiser patient on a 5150 hold needing medical admission''': Admit to Medicine at VMC with Inpatient Psych Consult (get EPRP approval)
*'''Kaiser patient on a 5150 hold who is medically cleared''': Discharge to EPS (EPRP will pass case along to Kaiser Behavioral Health Team)
**'''Kaiser patient under 18 years-old on a 5585 hold who is medically cleared''': Transfer to EMQ/Uplift

===Follow-Up & Discharge===
*[https://www.wikem.org/w/images/Requesting_a_PCP_for_patient.pdf Request a PCP for a patient]
**Send a new message to 'P HHS Panel Management [10907]' for the request
**Save as a QuickAction for next time
*'''Subspecialist referral''': place order in "Dispo" tab
**Okay to write "follow up of ED consult" for reason if patient seen by consultant in ED
**If EMR prevents you from placing referral (typically for VHP insurance patients), refer to PMD or any county UC (not EXC) for referral to be placed.
*'''Quality RN'''
**Can help out with:
***Filing DMV loss of consciousness form
***Additional ED lab / follow up requests
**Send a new message to 'P ED Quality Call Back Pool (Non-Urgent) [16010929]'
**Save as a QuickAction for next time
*[https://www.wikem.org/w/images/Sobering_Center_Info.pdf Sobering Center]: Mission Street 408-648-4411
**Must be an adult and able to walk or do own wheelchair transfers
*[http://edrcsv.org/wp-content/uploads/2017/12/MHUC_Brochure_July-2010.pdf Mental Health Urgent Care]
**Don Lowe Pavilion - blue door at corner of Enborg Lane & Enborg Court
**408-885-7855
*STI/HIV & [https://www.scvmc.org/clinics-and-locations/Lenzen/Pages/overview.aspx TB Clinic] Follow Up
**Look up "Crain STI" or "VHC Lenzen TB" clinics in Dispo
**976 Lenzen Ave, San Jose 95126
*[https://hhsconnect.sccgov.org/sites/vmc/ahed/Ambulatory%20Standardized%20Patient%20Education%20Material/Dental%20Clinic%20Locations%20and%20Hours.pdf#search=dental%20clinic Dental Clinics] | [https://www.wikem.org/w/images/Dental_Services.pdf Additional Dental Services]
*[https://www.wikem.org/w/images/Community_Health_Centers.pdf Partner Community Health Centers]
*[https://www.wikem.org/w/images/Creating_a_Personal_Follow_Up_List.pdf Create a Personal Follow Up List Instructions]

==Hospital Protocols==
*[https://hhsconnect.sccgov.org/Pages/policies-home.aspx VMC Policies & Procedures Webpage]
*[https://hhsconnect.sccgov.org/sites/vmc/pharmacy/Pages/references.aspx Pharmacy Protocols]
==See Also==
*[[SCVMC:Main| SCVMC Main Page]]
*[[SCVMC:EXC | SCVMC Express Care]]
*[[SCVMC:CUSTODY_CARE | SCVMC Custody Care]]

==References==
<references/>

Singh 4/2020
Bergersen 3/2020
[[Category:Admin]]