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| ''See [[Harbor:Main|Adult ED]] for the main adult Harbor page.'' | | ''See [[Harbor:Main|Adult ED]] for the main adult Harbor page.'' |
| ==Background==
| | ''This is the main page for Harbor-UCLA ''Pediatric'' ED; See [Harbor:Main|Adult ED]] for the main Harbor Adult ED page.'' |
| This is the main page for Harbor-UCLA Pediatric ED. | | |
| | ==Message of the Moment== |
| | Check here for the latest in Pediatric ED administrative news! |
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| ==General Administrative== | | ==General Administrative== |
| *[[Harbor:Peds ED schedule and sick backup plans|Schedule and sick backup plans]] | | *[[Harbor:Peds ED schedule and sick backup plans|Schedule and sick backup plans]] |
| **Resident shifts: EM, Pediatrics, Med-Peds
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| ***Most weekdays will be scheduled with residents (EM or Peds R2, R3, or R4) – two residents 7am-4:30pm, two residents 4pm-1:30am, and an EM or Peds R3 or R4 on mn-7:30am
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| ***Weekends and holidays and times of short staffing are likely to be scheduled with residents on 8a-8p, 7a-5p, 4p-2a, and an EM or Peds R3 or R4 on 8p-8a
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| ***Note: by our convention, a midnight – 7:30am shift listed on, for example, July 1st is actually technically on July 2nd. Thus, if you came in one minute early for your midnight-7:30am shift, you would come in at 11:59pm on July 1st. The attending schedules are done the same way.
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| ***Fellows may be scheduled for any of the resident shifts
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| **Intern and FM shifts
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| ***Depending on the number of interns and FM residents scheduled in the PED for a given block, they will be scheduled for 10a-7:30p, 3p-12:30a, and if there are enough rotators 10p-7:30a
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| **Attending shifts
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| ***There will be 24 hour attending coverage in the PED. The shifts will be 7a-4p, 4p-12mn, and 12mn-7am
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| **Teaching rounds
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| ***Teaching will occur 7a-7:30a, and may occur 4p-4:30p
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| ****Overnight residents are NOT to leave early before 7:30a, and all residents should get breakfast at 6:45a so they can be present for teaching rounds
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| ***Huddle (with nursing) will occur at 7:15a
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| **Trading shifts
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| ***Day and swing resident shifts always have at least one EM person or PEM fellow; this is because we need someone present who has experience with trauma
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| ***EM residents (R2, R3, R4)
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| ****May trade with other EM residents or PEM fellows
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| ****May trade a PED shift with an AED shift
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| *****This will be logged as a switch shift
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| *****Only R3s, R4s, or PEM fellows can do the overnight shifts
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| *****EM R3s & R4s may trade overnight shifts only (no other type of shift) with Harbor Peds R3s
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| ***Pediatric, Med-Peds, and FM residents
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| ****May trade with each other
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| ****Only a Harbor Peds R3 can do an overnight (non-Harbor residents will not have the familiarity with Harbor that is needed)
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| ****Harbor Peds R3s may trade overnight shifts only (no other type of shift) with EM R3s or R4s
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| ****Peds, Med-Peds, and FM residents can also get someone of equal or higher level from their program to cover a shift and pay that person back however they like
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| *****Would expect this would just be one shift though, so it doesn’t overly impact your PED rotation
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| ***Interns and FM residents
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| ****Interns may trade with each other or with FM residents scheduled in a 10a-7:30p or 3p-12:30a shift
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| ****May also get another intern from their program (or any EM or Peds intern) to cover their shift
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| ***Get your trade approved
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| ****Trade cannot incur an RRC duty hours violation
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| ****Send your proposed trade to kyoung@emedharbor.edu AND christiane@emedharbor.edu for review
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| ****Have BOTH people involved in the trade email to assure that they agree (one person can forward an email in which the other agrees)
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| ****Do this well in advance so your trade can be properly reviewed
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| **Sick Back-up Plans
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| ***If you are too sick to work your shift, or think you may be too sick, please call and notify people as early as possible
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| ***Notify Kelly Young at kyoung@emedharbor.edu, Christiane at christiane@emedharbor.edu, AND call the current PED attending at 310-222-6939
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| ****EM residents contact Madonna Fernandez or the chief residents
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| ****Peds residents contact your chief resident
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| ****FM residents contact Theresa Nevarez or your chief residents
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| ****UCLA Med-Peds residents contact your chief resident
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| ***If 7a-4:30pm resident is sick
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| ****Jeopardy coverage for EM residents
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| ****Coverage from own program for Peds or Med-Peds residents
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| *****If no coverage available, and PED is very busy, EM jeopardy may be called
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| ****Other 7a-4:30pm resident becomes 7a-5p, 4pm-1:30am resident becomes 8a-8p (or as close as possible depending on previous shift and current time), 4p-1:30am resident becomes 4p-2a, and mn-7:30am resident becomes 8p-8a
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| ***If 4p-1:30am resident is sick
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| ****Jeopardy coverage for EM residents
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| ****Coverage from own program for Peds or Med-Peds residents
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| *****If no coverage available, and PED is very busy, EM jeopardy may be called
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| ****One 7a-4:30pm resident becomes 7a-5p and one becomes 8a-8p, the other 4p-1:30am resident becomes 4p-2a and the mn-7:30am resident becomes 8p-8a
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| ***If mn-7:30am resident is sick
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| ****Jeopardy coverage from own program (EM or Peds)
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| ***If EM resident is jeopardized, will attempt to arrange payback coverage, including from Peds or UCLA residents
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| *[[Harbor:Peds ED follow-up track information|Follow-up track information]] | | *[[Harbor:Peds ED follow-up track information|Follow-up track information]] |
| **Place lab checks for any lab that will not result during the patient's visit
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| ***Examples: urine/throat/wound cultures, urine GC/Chlamydia, pertussis PCR, thyroid function tests
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| ***Use the ED Post Visit Plan on the Depart Process
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| ****Get a phone number where the patient can be reached best
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| ****Click Lab/Radiology follow-up
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| ****Specify result to be checked and plan
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| ****If you don't do this while the patient is still on the track, you need to do an extra step: Events->Request Event->ED Post Visit Peds, or else they will not be on the f/u track (HAR Follow Up)
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| **You can order phone f/u calls to check on patient's symptoms
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| ***Do as for lab check above, except check Symptom Follow-up and specify what symptoms to ask about
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| **If a patient can be seen at Harbor (not OOP), you can put in for a referral
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| ***Do as for lab check above, except check Referral and specify what referral is needed
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| **Phone and lab checks will be done by NPs on Mon, Tues, Thurs, Fri and by the 10am-7:30pm intern / resident on Wed, Sat, Sun, holidays
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| **Detailed instructions are in a binder labeled "F/U Instructions" in the PED, and on Pemsource.org on the Harbor page
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| ==Managing your Patient== | | ==Managing your Patient== |
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| ***Remember that pediatric medications are often dosed on a per kg basis | | ***Remember that pediatric medications are often dosed on a per kg basis |
| ***Cerner does not automatically stop at a maximum dose, so check that you are not ordering more than an adult dose | | ***Cerner does not automatically stop at a maximum dose, so check that you are not ordering more than an adult dose |
| | **Separate Saline Lock order is not needed if you are ordering an IV medication or IV bolus |
| | ***If you are ordering a blood draw and want an IV also, must separately order saline lock |
| *[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]] | | *[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]] |
| *[[Harbor:Ultrasound Approval List|Ultrasound approval list]] | | *[[Harbor:Ultrasound Approval List|Ultrasound approval list]] |
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| ===Documenting=== | | ===Documenting=== |
| *[[Harbor:Attending documentation|Attending documentation]] | | *[[Harbor:Attending documentation|Attending documentation]] |
| *[[Harbor: Consenting a Patient|Consenting a Patient]] | | *[[Harbor:Consenting a patient|Consenting a Patient]] |
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| ===Procedures=== | | ===Procedures=== |
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| *[[Harbor:Paging|Paging consults]] | | *[[Harbor:Paging|Paging consults]] |
| *[[Harbor:Consultation of subspecialists (peds)|Consultation of subspecialists]] | | *[[Harbor:Consultation of subspecialists (peds)|Consultation of subspecialists]] |
| **For pediatric patients (< 21 years old), pediatric medical subspecialists are consulted | | *[[Harbor:Equipment and supplies (peds)|Equipment and supplies]] |
| ***MedHub Harbor call schedule (link from PEMsource.org Harbor only page), choose Pediatrics
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| ***Peds Department Pagers also posted in PED docbox and linked on PEMsource.org Harbor only page
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| **For surgical subspecialties (eg Ortho, ENT, Ophtho, Neurosurg, Plastics, Derm, Urology, OMFS), use the on-call schedule as for adult patients except:
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| ***General surgery, consult resident on Pediatric surgery pager 6105 Mon-Fri 8am-5pm
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| ****Otherwise, consult Trauma surgery
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| **For Psychiatry
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| ***Mon-Fri 8am-4pm call the Child and Adolescent Psychiatry fellow
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| ****MedHub Harbor call schedule (link from PEMsource.org Harbor only page), choose Psychiatry -> Child and Adolescent Psychiatry
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| ***After hours and on weekends and holidays, call Psych ED for Psychiatry resident on call x3144
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| ===Special patient types=== | | ===Special patient types=== |
| | *For patients followed in a pediatric subspecialty clinic, particularly Hematology-Oncology & Cardiology, call the subspecialist on call to notify them of the patient's ED visit |
| | *[[Harbor:PED psych patients|Psychiatric patients]] |
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| ==Patient Disposition== | | ==Patient Disposition== |
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| *[[Harbor:Paging|Paging consultants]] | | *[[Harbor:Paging|Paging consultants]] |
| *[[Harbor:Pediatric admission guidelines|Admission guidelines]] | | *[[Harbor:Pediatric admission guidelines|Admission guidelines]] |
| **Patient age
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| ***Pediatric ward and PICU admit patients up to age 21 years and 364 days old
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| ****If another service is asking to admit an adult patient aged 18-21 years, state that the patient should be admitted to pediatrics with the other service consulting
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| ***Patients < 1 month old with no respiratory symptoms or diarrhea may potentially be admitted to NICU or nursery
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| ****Discuss with admitting nursery (x2311) or NICU (x2340) resident
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| **ED attendings have admitting privileges
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| ***Admissions will be accepted by pediatric residents regardless
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| ****Pediatric residents, in conjunction with their attending, may evaluate the patient and perform an immediate discharge if they so desire
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| **ED attendings determine, with admitting resident input, the appropriate location: ward, step-down, PICU
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| **ED should have done all of the following prior to contacting the admitting resident
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| ***Complete necessary work-up and treatment for stabilization that should occur acutely in the ED
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| ***Make sure with Utilization Review that the patient can be admitted to Harbor
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| ****If the attending says patient is not stable for transfer, then the patient will be admitted
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| ****The Interqual icon does NOT have to be green prior to contacting admitting resident IF ED staff are sure the patient will be admitted to Harbor
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| **Peds does not have isolation areas, so if patient needs isolation (eg active TB, meningococcemia, measles, varicella), discuss with admitting resident
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| ***Patient may need to be admitted to an adult area and followed by peds, or transferred
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| **Contacting admitting resident
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| ***Harbor MedHub call schedule (linked from PEMsource.org Harbor only page)
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| ***Protected time
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| ****Weekdays 6:45am-7:30am
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| ****Weekends 7:45am-8:30am
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| ****All evenings 7pm-7:30pm
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| ***For ward and step-down
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| ****Mon-Fri 7a-7p: Pediatrics Ward Senior Admit resident (will be Gold or Blue, depending on which team is admitting)
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| ****Mon-Fri 7p-7a: Pediatrics PM Ward Senior
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| ****Sat-Sun 24 hours: Pediatrics Ward Senior Admit resident
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| ****If unsure, can call Peds ward at x2333 to ask for admitting resident
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| ***For PICU
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| ****Mon-Fri 7a-7p: Pediatrics PICU
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| ****Mon-Fri 7p-7a: Pediatrics PM PICU
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| ****Sat-Sun 24 hours: Pediatrics PM PICU
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| ****If unsure, can call PICU at x2480 to ask for admitting resident
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| ***If you forget to ask, the Attending name for Ward Blue or Gold team, or PICU will be listed on MedHub
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| **After admission
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| ***Once the ED staff puts in a "Request for Admit" order, the pediatrics team is managing the patient
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| ****ED staff should have all ED orders in and completed prior to putting in Request for Admit
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| *****Make sure nursing has had a chance to complete ED orders prior to putting in Request for Admit
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| ***As part of their admission orders, pediatric residents may order additional labs, imaging, etc.
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| ****These do NOT need to be done in the ED prior to the patient going upstairs
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| ****Ultrasounds can be difficult to obtain from inpatient, so attempt to get any ultrasounds done prior to leaving ED
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| ***For any delays in patient going upstairs, have nursing contact Patient Flow
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| ===Other=== | | ===Other=== |
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| ==[[Harbor:Disaster info|Disaster]]== | | ==[[Harbor:Disaster info|Disaster]]== |
| *[[Harbor:Disaster info|General disaster info]] | | *[[Harbor:Disaster info|General disaster info]] |
| *[[Harbor:Surge plan]] | | *[[Harbor:Surge plan|Surge Plan]] |
| *[[Harbor:Ebola|Suspected Ebola protocol]] | | *[[Harbor:Ebola|Suspected Ebola protocol]] |
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| ==See Also== | | ==See Also== |
| *[[Harbor:Main]] | | *[[Harbor:Main]] |
| *[[Harbor:Operations manual]]
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| [[Category:Admin]] | | [[Category:Admin]] |
