Harbor:Pediatric ED (main): Difference between revisions
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==Managing your Patient== | ==Managing your Patient== | ||
Revision as of 20:58, 13 August 2016
See Adult ED for the main adult Harbor page.
Background
This is the main page for Harbor-UCLA Pediatric ED.
General Administrative
Managing your Patient
Ordering
- Use the Peds ED tab on Cerner Place Orders for PED quick orders
- For medication orders
- 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
- For medication orders
- Ordering a Formal Ultrasound
- Ultrasound approval list
- Ordering a CT
- Ordering Blood Products
- Ordering antibiotics
Documenting
Procedures
Finding Things
- Paging consults
- Consultation of subspecialists
- For pediatric patients (< 21 years old), pediatric medical subspecialists are consulted
- MedHub Harbor call schedule (link from PEMsource.org Harbor only page), choose Pediatrics
- Peds Department Pagers also posted in PED docbox and linked on PEMsource.org Harbor only page
- For surgical subspecialties (eg Ortho, ENT, Ophtho, Neurosurg, Plastics, Derm, Urology, OMFS), use the on-call schedule as for adult patients except:
- General surgery, consult resident on Pediatric surgery pager 6105 Mon-Fri 8am-5pm
- Otherwise, consult Trauma surgery
- General surgery, consult resident on Pediatric surgery pager 6105 Mon-Fri 8am-5pm
- For Psychiatry
- Mon-Fri 8am-4pm call the Child and Adolescent Psychiatry fellow
- MedHub Harbor call schedule (link from PEMsource.org Harbor only page), choose Psychiatry -> Child and Adolescent Psychiatry
- After hours and on weekends and holidays, call Psych ED for Psychiatry resident on call x3144
- Mon-Fri 8am-4pm call the Child and Adolescent Psychiatry fellow
- For pediatric patients (< 21 years old), pediatric medical subspecialists are consulted
Special patient types
Patient Disposition
Discharging a Patient
Admitting a patient
- Paging consultants
- Admission guidelines
- Patient age
- Pediatric ward and PICU admit patients up to age 21 years and 364 days old
- 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
- Patients < 1 month old with no respiratory symptoms or diarrhea may potentially be admitted to NICU or nursery
- Discuss with admitting nursery (x2311) or NICU (x2340) resident
- Pediatric ward and PICU admit patients up to age 21 years and 364 days old
- ED attendings have admitting privileges
- Admissions will be accepted by pediatric residents regardless
- Pediatric residents, in conjunction with their attending, may evaluate the patient and perform an immediate discharge if they so desire
- Admissions will be accepted by pediatric residents regardless
- ED attendings determine, with admitting resident input, the appropriate location: ward, step-down, PICU
- ED should have done all of the following prior to contacting the admitting resident
- Complete necessary work-up and treatment for stabilization that should occur acutely in the ED
- Make sure with Utilization Review that the patient can be admitted to Harbor
- If the attending says patient is not stable for transfer, then the patient will be admitted
- 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
- Peds does not have isolation areas, so if patient needs isolation (eg active TB, meningococcemia, measles, varicella), discuss with admitting resident
- Patient may need to be admitted to an adult area and followed by peds, or transferred
- Contacting admitting resident
- Harbor MedHub call schedule (linked from PEMsource.org Harbor only page)
- Protected time
- Weekdays 6:45am-7:30am
- Weekends 7:45am-8:30am
- All evenings 7pm-7:30pm
- For ward and step-down
- Mon-Fri 7a-7p: Pediatrics Ward Senior Admit resident (will be Gold or Blue, depending on which team is admitting)
- Mon-Fri 7p-7a: Pediatrics PM Ward Senior
- Sat-Sun 24 hours: Pediatrics Ward Senior Admit resident
- If unsure, can call Peds ward at x2333 to ask for admitting resident
- For PICU
- Mon-Fri 7a-7p: Pediatrics PICU
- Mon-Fri 7p-7a: Pediatrics PM PICU
- Sat-Sun 24 hours: Pediatrics PM PICU
- If unsure, can call PICU at x2480 to ask for admitting resident
- If you forget to ask, the Attending name for Ward Blue or Gold team, or PICU will be listed on MedHub
- After admission
- Once the ED staff puts in a "Request for Admit" order, the pediatrics team is managing the patient
- ED staff should have all ED orders in and completed prior to putting in Request for Admit
- Make sure nursing has had a chance to complete ED orders prior to putting in Request for Admit
- ED staff should have all ED orders in and completed prior to putting in Request for Admit
- As part of their admission orders, pediatric residents may order additional labs, imaging, etc.
- These do NOT need to be done in the ED prior to the patient going upstairs
- Ultrasounds can be difficult to obtain from inpatient, so attempt to get any ultrasounds done prior to leaving ED
- For any delays in patient going upstairs, have nursing contact Patient Flow
- Once the ED staff puts in a "Request for Admit" order, the pediatrics team is managing the patient
- Patient age