Harbor:Main: Difference between revisions
 
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==Background==
''This is the main page for Harbor-UCLA emergency department; See [[Harbor:Pediatric ED (main)|Pediatric ED]] for the main Harbor pediatric page.''
This is the mainpage for Harbor-UCLA Residency Administration Section.
==Admin Updates==
* Newsletter
** [https://harbor-ucla-ed-t7sies2.gamma.site/ The Newsletter: Shorter + Mobile & Desktop Friendly Version]
** [https://lacounty.sharepoint.com/:w:/t/EDOperations-HUCLA/IQBUmapSQpzbR58_p7oa04d3AfmdWb0SBGZt4ND0Q6Wd4Mo?e=rEbPc8 The Full Newsletter: Word Doc]


==Task-Specific Pages==
*New!
*Initiating Patient Contact
** [[Harbor: Surge Team Checklist|Surge Team Checklist]]
*Managing your Patient
** [[Harbor:Sepsis_core_measures|Sepsis Core Measure (SEP-1) Tips]]
**Ordering
** [[Harbor:_ED_to_UCC#ED_to_UCC|ED to UCC (11-12-2025)]]
***[[Harbor:Ordering an Ultrasound|Ordering an Ultrasound]]
** [[Harbor:OOP_follow_up_options|OOP Urgent Specialty Referral Process 8-18-2025]]
***[[Harbor:Ordering a CT|Ordering a CT]]
** [[Harbor: ED ECMO|Harbor ED ECMO]]
***[[Harbor:Ordering Blood Products|Ordering Blood Products]]
** [[Joint_Commission_(JC)_Readiness|Joint Commission (JC) Readiness]]
**Documenting
***[[Harbor: Wellsoft Cheat Sheet (Physician or Mid-Level)|Wellsoft Cheat Sheet]]
**[[Harbor:Finding Things|Finding Things]]
*Patient Disposition
**[[Harbor:Discharging a Patient|Discharging a Patient]]
***[[Harbor:Referrals|Referrals]]
***[[Harbor:Prescribing|Prescribing]]
**[[Harbor:Admitting a Patient|Admitting a Patient]]


==General Information==
==Frequently Utilized Resources==
* QR:  [https://wikem.org/wiki/Harbor:QR_for_Staff QR Code:  ED Ops Issues, Equipment issues, Prehospital problems, Inappropriate Referrals for Specialty Care (OOP Patients), Med Student evals, Resident Shout-outs]


==Common Administrative Pitfalls==
* MRI [[Harbor:STAT_MRI|Ordering a MRI]]
 
* Antibiogram [https://lacounty.sharepoint.com/:u:/r/sites/dhs-harbor-inf_prev_ctrl/SitePages/Antimicrobial-StewardshipProgram.aspx?csf=1&web=1&share=ERuEQuuNVS1NoY4WBjq2PY0BqoRe2Q7cJyVcYx1or1VeFg&e=MG7YxZ 2025 Inpatient and Outpatient Antibiograms + DHS Prescription Formulary with Pricing]
 
* Asthma (for QIP): Symbicort preferred (formeterol – long-acting B-agonist + budesonide – inhaled corticosteroid), 2nd line is Advair (salmeterol + fluticasone);  be sure to refill their controller medication AND the albuterol (if needed).  We fall out if they fill more albuterol Rx’s in a year than their controller medication.  If prescribing albuterol, do not give refills (you get 200 puffs!).
 
*Patient Relations Representatives (PRR) 3p-2a, 7days a week – call Registration for PRR who can help empanel into DHS or change empanelment/network in real time in the ED. PRR can come to bedside to meet with patient or send patient to Registration Windows. During business hours, send patient to Patient Relations Office in Rm 1-B-1.
==Triage/RME/Surge Team==
 
* [[Harbor:Screening EMS Patients|Ambulance Triage]]
 
* [[Harbor:RME & TRIAGE|RME & triage]]
 
* [[Harbor:Surge_plan|Surge Criteria/Plan]]
 
==Specialty Care/Consults==
*ID
** [[Harbor:Infectious_Disease_Threats#Measles|Measles]]
** [[Harbor:Infectious_Disease_Threats#Flu%2FILI|Avian Flu]]
** [https://wikem.org/wiki/Harbor:Infectious_Disease_Threats#Treatment Covid Treatment Options]
** '''Harbor's COVID page''' [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
*** Paxlovid, Remdesivir, etc ... [[Harbor:Infectious_Disease_Threats#Treatment|COVID Treatment Options]]
** '''Monkeypox'''
*** See [[Monkeypox]] for medical information  &  [[Harbor:Infectious_Disease_Threats#Monkeypox|Harbor Monkeypox Plan]]
*** Educational Material
**** [http://publichealth.lacounty.gov/acd/Monkeypox.htm LA County Monkeypox]
**** [http://publichealth.lacounty.gov/media/monkeypox/docs/Monkeypox_IntimateContact.pdf LAC DPH Monkeypox]
**** http://publichealth.lacounty.gov/media/monkeypox/resources.htm#reduce
**** [https://www.cdc.gov/poxvirus/monkeypox/resources/print.html CDC Monkeypox]
 
*OB/GYN
**[https://lacounty-my.sharepoint.com/:w:/g/personal/kwilhelm_dhs_lacounty_gov/EXx3Qx36PYRJhQitVemtv7gBCWILqG_2SvTJQjdXZ-S4lQ?e=xuWoPX OB/GYN Consult and Follow Up Guidelines]
 
 
* Optho: [[Harbor:Ophtho abbreviation dictionary]]
 
 
* Ortho
** [https://lacounty.sharepoint.com/:w:/t/EDOperations-HUCLA/ES3s8sXJdKBLpukbDXsHZfoBwhQCS17ogqrR8mC2TVNvcQ?e=xp82nc Ortho Consult Criteria]
** [https://wikem.org/wiki/Harbor:ED_follow-up_options#ORTHO Ortho:  Splint vs Consult]
** [[Harbor:_Ortho_Outpatient_CT|Ortho Outpatient CT]]
 
==Disposition==
* '''Interqual criteria''' [[Harbor:Interqual_Criteria_Tips|Interqual Criteria Tips]]
** [[Harbor:Interqual_Criteria_Tips|InterQual Criteria]]
 
*Obs
** [https://wikem.org/wiki/Harbor:Placement_patients Placement Patients]
** [[Harbor:Neuro Obs & RLA Transfers|Harbor Neuro Obs & RLA Transfers]]
 
* Admits
** [[Harbor:Admission_and_consultation_guidelines|Admission Guidelines]]
** [[Harbor:Right_level_of_care|Right Level of Care]]
** [[Harbor:Direct_Admission_after_Hours|Direct Admissions and Admissions from Clinic How-to Guide]]
**[[Harbor:Direct Admission after Hours]]
 
 
 
* Transfers
** [https://wikem.org/wiki/Harbor:Transfers Re-plant, Burns, Stroke, STEMI, Hyperbaric, L&D, Psych/Exodus]
** [https://wikem.org/wiki/Harbor:Psych_patients Psych:  OSA, Covid, & Exodus]
** If UR is suggesting a transfer to Rancho Los Amigos (RLA), then place the ‘consult to Transfer Center’ order. The Transfer Center is a county entity that helps transfer patients between county facilities. 
 
 
 
* Discharges
** [[Harbor:ED_follow-up_options|Discharging to Clinics]]
** [https://lacounty.sharepoint.com/:w:/s/medicineoutpatientspecialtycare/ESLCad7IJDxCjklxFLNfWwIBUJUwhIar7dLm90WEL1Q-dQ?CID=0533F57A-1097-40F3-B225-6179CAD98347&wdLOR=c0DBF4B05-F1CA-4BAD-9ABB-0D52156AED09 ED to Specialty Clinic DC - please check instructions for each specific clinic prior to making an appointment]
*** [[Harbor:OOP_follow_up_options|'''OOP Urgent Specialty Referral Process''' 8-18-2025]]
** [https://wikem.org/wiki/Harbor:Expedited_Work-up_Clinic_(EWC) Expedited Workup Clinic (EWC)]
** [https://www.wikem.org/wiki/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis Breast Abscess]
** [https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Breast_mass.2Fmalignancy Breast Mass]
** [[Harbor:ED_follow-up_options#BURN_CENTER_CLINIC|July 4th - Outpatient USC Burn Center Follow-up]]
** [[Harbor:_Social_Discharges|Social Discharge Options]]
 
==Diagnostics==
* MRI [[Harbor:STAT_MRI|Ordering a MRI]]
 
*Synapse got a new look. See link for details. A [https://lacounty.sharepoint.com/:b:/s/dhs-eci/ESN8ppJYxPZGhUcV9ZGyWYMB8do8sVnRqmBWuNyKG5x-7A?e=RpdAsg one-page intro guide] are available on [https://lacounty.sharepoint.com/sites/dhs-eci/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2Fdhs%2Deci%2FShared%20Documents%2FRadiology%2FPACS%205%2E7%20Upgrade%2FGuides%2FQuick%20Start%20Tutorial&p=true&originalPath=aHR0cHM6Ly9sYWNvdW50eS5zaGFyZXBvaW DHS SharePoint]
**Alt+C still works to compare studies.
**Open the PowerJacket (folder icons) and then you can pull up the read on 'reports'. Click the dropdown to switch from 'report' to 'notes' to find a free text prelim read.
**Change your default settings to what PowerJacket looks like and select ‘Notes’ and ‘Reports’ to always open so you can see prelim and final reads, respectively.
 
 
 
 
==Legal/Quality Improvement/Safety==
* Legal
** [[Harbor:Legal#Law_Enforcement_in_the_ED|Law Enforcement in the ED (ICE)]]
 
* QI Projects
**[[Harbor:Core Measures|Core Measures]]
** [https://dhs.lacounty.gov/harbor-ucla-medical-center/work-or-partner-with-us/la-drop/ LA Drop (Prehospital Blood)]
 
*Safety
** '''Active Threat in the ED'''
*** Situational awareness
**** Stand between door and patient
**** Ensure patient is gowned
**** Be aware of long stethoscope, lanyard, long hair, etc
**** Panic buttons at nursing stations/router
**** Run & scream for help
*** Hospital Codes
**** Gold x111 - combative/agitated patient
**** Gray x64450 - combative/agitated NON-patient
**** Silver x111 - weapon, active shooter, hostage
 
==[[Harbor:Pediatric_ED_(main)|PED]]==
 
**[[Harbor:Crown Checks in PED|Crown Checks in PED]]
 
==Welcome to Harbor-UCLA (Orientation)==
*[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]
**[[Harbor: Macros and Autotext|Macros and Autotext]]
*[[Harbor:Attending documentation|Attending Documentation]]
*[[Harbor:Resident documentation|Resident documentation]]
 
==Old Material==
*Pre-hospital
**[[Harbor:Incoming transfers|Incoming transfers]]
**Exodus Transfers
***Exodus should call Psych ED about transfer, not Med ED
***Med ED will do MSE
*DEM AOD [[Harbor:DEM_Admin_on_Duty_(AOD)|DEM Admin on Duty (AOD)]]
* [[Harbor:Resident responsibilities and transitions of responsibility|Resident Responsibilities]]
 
 
===Administrative duties===
**[[Harbor:Administrative resident|Administrative resident directions]]
**[[Harbor: Phone Calls|Receiving Phone Calls]]
***[[Harbor:Critical Result Callback|Critical Result Callback]]
**[[Harbor:EKG screening|EKG Screening]]
**[[Harbor:5S|Pre-shift: 5S]]
**Airway Bag [[Harbor:Airway_management_team]]
 
===Administrative resources===
===[[Harbor:ED policy manual|Harbor ED policy manual]]===
===[[Harbor:ED attending on call plan|ED attending on call plan]]===
 
===[[Harbor:Legal|Harbor Legal]]===
 
==Managing your Patient==
===General===
====[[Harbor:PC Cheat Sheet|On shift (PC) Cheat Sheet]]====
 
====[[Harbor:Paging|Paging consultants]]====
 
====[[Harbor:Phone numbers|Phone numbers]]====
====[[Harbor:Radiology directory|Radiology directory]]====
 
===Tests & Orders===
*[[Harbor:Labs|Labs]]
 
 
===Radiology===
====[[Radiology Hours]]====
[[https://wikem.org/wiki/Harbor:Radiology_directory#Radiology_Directory| Radiology Directory]]
 
====[[Harbor:STAT MRI|STAT MRI]]====
*[[Harbor:ED Radiology Specs|MRI Specs]]
 
==== [[Interventional Radiology (IR)]] ====
* When discussing the case with IR, the ED provider needs to clarify if the patient will require sedation for the procedure and communicate this plan to the ED bedside nurse
* Two pathways from the ED:
** '''Patient requires sedation''' for the procedure – they will be '''recovered in the PACU'''
*** If patient is being discharged, the patient will be DC’d from PACU
*** If patient is being admitted, the patient will go to their assigned inpatient room or board in the PACU
** '''Patient does not require sedation''' for the procedure
*** They will be '''returned to the ED after the procedure'''
 
====US & QPathE====
* [https://dhsqpath.qpath.cloud '''QPathE Login link''']
** Login using e# and associated password
** Double-click the exam
** Click "edit" at the top of the page
** Enter MRN in the "patient ID" box
** in "comments" enter trauma FAST
** Click save at top of screen
 
 
*Ultrasound
**[[Harbor:Ordering a Formal Ultrasound|Ordering a Formal Ultrasound]]
**[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
**[[Endocavitary Probes]]
*[[Harbor:Entering Prelim Radiology Read|Enter Prelim Rads Read]]
*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
*CT
**[[Harbor:Ordering a CT|Ordering a CT]]
**[[Harbor:ED Radiology Specs|CT Specs]]
 
====Contrast====
* [[Creatinine_screening_prior_to_IV_contrast|IV Contrast]]
** [https://lacounty.sharepoint.com/sites/dhs-harbor-pharm/PrePrinted%20Forms/Forms/AllItems.aspx?id=%2Fsites%2Fdhs%2Dharbor%2Dpharm%2FPrePrinted%20Forms%2FExtravasation%20Management%20Provider%20Order%20Form%20P294%20%2810%2E6%2E20%29%2Epdf&parent=%2Fsites%2Fdhs%2Dharbor%2Dpharm%2FPrePrinted%20Forms| Hyaluronidase for IV Contrast Extravasation order Form]
* [[Oral contrast for abdominal and pelvic CT|Oral Contrast]]
 
====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
 
===[[Harbor:Ordering Blood Products|Blood products]]===
 
===[[Harbor:Antibiogram|Antibiogram]]===
**[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
***[[Harbor:Sepsis core measures|Sepsis core measures]]
 
===Finding Equipment/DME===
*[[Harbor:Equipment|Equipment (AED/RME)]]
*[[Harbor:Equipment and supplies (peds)|Equipment (peds)]]
*[[Harbor:DME|Durable Medical Equipment (DME)]]
 
====[[Harbor:ED supplies A-Z|ED supplies A-Z]]====
 
===Procedures===
*[[Harbor:Consenting a patient|Consenting a patient]]
*[[Harbor:Procedures Videos|Procedure Videos]]
 
==Special patient types==
===[[Harbor:Codes|Code Activations]]===
*[[Harbor:Involuntary holds|Involuntary Holds]]
*[[Harbor:Airway management team|Airway Consults to Anesthesia & Airway Management Team]]
*[[Harbor:Code stroke|Code Stroke]]
*[[Harbor:Code STEMI|STEMI Activation]]
*[[Harbor:Trauma activations|Trauma Activations]]
*[[Harbor:PE Response Team|PE Response Team (PERT)]]
 
===[[Harbor:Placement patients|'''Placement patients''']]===
===[[Harbor:Psych patients|Psych Patients, Code Gold, & Exodus]]===
===[[Harbor:Scheduled dialysis patients in ED|Scheduled dialysis patients in ED]]===
==='''[[Harbor:Non-Occupational Exposure|Sexual Assault/STI Exposure (SART)]]'''===
==='''[[Harbor:Occupational exposure|Occupational Exposure]]'''===
*[[Harbor:Industrial Accident (IA)|Industrial or On-the-Job Accidents (IA)]]
===[[Harbor Radiation Precautions|Harbor Radiation Precautions]]===
===[[Harbor:NFL Injured Player/Staff Protocol|NFL Injured Player/Staff Protocol]]===
 
===Substance Use Disorder (SUD) Treatment Options===
*[[Harbor:Opiate Withdrawal/MAT/BUP|Opiate Withdrawal/MAT/BUP]]
*[[Harbor:Alcohol Use Disorder/Withdrawal Treatment]]
*[[Harbor:Stimulant Use Disorder Treatment]]
*[[Harbor:Cannabis_Abuse|Cannabis (THC) Use Disorder (CUD) Treatment Options and Resources]]
 
===[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]===
*[[Harbor:Sepsis core measures|Sepsis core measures]]
*[[Harbor:Antibiotics in Sepsis|Harbor antibiotics in sepsis]]
*[[Harbor:Infectious_Disease_Threats#Coronavirus_.28COVID-19.29|'''COVID''']]
*[[Harbor:Ebola|Suspected Ebola protocol]]
*[[Harbor:Infectious_Disease_Threats#Monkeypox\Monkeypox]]
 
===[[Harbor:Social work|Social Work]]===
*[[Harbor: Reporting to DCFS|Reporting to DCFS]]
*[[Harbor: Identifying Jane/John Doe, finding next of kin tips]]
*[[Harbor:Baby Safe Surrender Program|Baby Safe Surrender Program]]
===Crown Checks===
*Screening L & D patients:  If a pregnant person is brought back to the PED for an evaluation, it should be for active labor and the urge to push. 
** If the pregnant person has the urge to push, we are doing a crown check – that is looking to make sure the head is not visible.  We are not doing a complete internal exam. If no head is visible and everything else seems okay, we do a quick MSE note and the patient is sent upstairs to L & D after the nurses call up and let them know they are coming up. 
** Caveats:
*** If the pregnant person is having contractions and the baby appears to be premature below 37 weeks (especially less than 32 weeks) and delivery seems to be imminent (water broke, contractions very close together, etc) consider calling OB batch as the baby can be born through only a partially dilated cervix with little pushing. We do not want this to happen in the elevator. 
*** If the birthing person has had multiple pregnancies/deliveries, the baby can be born rather quickly; be more conservative in your clinical judgement to transfer to OB.
*** Vaginal bleeding – if the birthing person is having significant vaginal bleeding, then OB should be called down to us for evaluation – using the OB batch pager gets them down quickly. 
*** Please use your medical knowledge to determine the risk to the birthing person and the chances the baby could be born in the elevator.  If in doubt call OB batch page for OB to come down to evaluate the situation (I frequently have them come down for micropremies to check to see how imminent delivery is rather than sending upstairs with the risk of delivering in the elevator).
===Patients requiring ED D&C===
*If an ED patient requires a dilation and curettage (D&C) for indications such as spontaneous miscarriage or retained products of conception, it can be performed in the adult or pediatric ED’s in collaboration with the OB/GYN team.  Once the patient has been consented by the OB/GYN team, they can administer a bedside paracervical block and provide additional analgesia within their scope of practice. If the patient requires (or requests) procedural sedation to facilitate the procedure, this should be discussed with the ED Attending. The ED Attending will determine whether procedural sedation is feasible based on the ED team's capacity and the current state of the department.
*The estimated sedation time may vary based on the clinical situation, but it is generally expected to be 10-15 minutes.  If adequate sedation or analgesia cannot be provided by OB/GYN at the bedside, the ED team is unable to perform procedural sedation, or sedation is expected to take >20 minutes, the procedure should be performed in the operating room with Anesthesia. All decisions regarding the location of the D&C should be patient-centered and involve direct communication between the attending physicians.
*For elective abortions, have the patient call 1-877-CARE121 8am-5pm M-F and provide patient handout "Pregnancy Options" under Custom Patient education.
 
==Patient Disposition==
===Discharge===
====[[Harbor: ED Follow-Up Options|'''ED Follow-Up Options''']]====
*[[Harbor:Prescribing|Prescribing]]
 
====[[DC with meds in ED]]====
* Eye drops (vanco & tobra) and STI prophylaxis for home
* HIV prophylaxis for sexual assault patients (raltegravir and Truvada)
 
 
 
*'''[[Harbor:Forms| Paper Forms]]'''
 
*[[Harbor:Coumadin clinic|Coumadin clinic]]
*[[Harbor:Expedited workup clinic|Expedited workup clinic]]
*[[Harbor:Law Enforcement Discharge Escort|Law Enforcement Discharge Escort]]
*[[Harbor:Home Health|Home Health]]
*[[Harbor:Home hospice from ED]]
 
====[[Transportation Needs]]====
 
 
====[[Social EM resources]]====
 
===Admission===
====[[Harbor:Admission and consultation guidelines|'''Admission Guidelines''']]====
*[[Harbor:Admitting a patient|Admitting a patient]]
*[[Harbor:Who Goes to Family Medicine|Who Goes to Family Medicine]]
====[[Harbor:Interqual Criteria Tips|Interqual Criteria Tips]]====
 
====[[Harbor:Interqual Override Notes|Interqual Override Notes]]====
 
====[[Harbor:Right level of care|Right level of care]]====
*Admitting to Medicine - use MS Teams (no more clipboard)
*[[Harbor:Post-admission management|Post-admission management/Orders on Admitted Patients]]
*[[Harbor:Direct Admission after Hours|Direct Admission after Hours]]
 
====[[Harbor:Neuro Obs & RLA Transfers|Neuro Obs & RLA Transfers]]====
 
===OBS & CORE===
*[[Harbor:Observation placement|Observation placement]]
*[[Harbor:CORE|CORE placement]]
 
 
===[[Harbor:Scheduled_dialysis_patients_in_ED|Dialysis in the ED]]===
===Other Disposition===
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
* [[Harbor:Deceased patients|Deceased patients]]
==Documentation==
 
*[[Harbor:Consenting a patient|Consenting a Patient]]
**[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]
 
==Disaster & Surge==
*[[Harbor:Disaster plan|Disaster plan]]
*'''[[Harbor:Surge plan|Surge plan]]'''
*[[Harbor:ORCHID Downtime|ORCHID Downtime]]
*[[Harbor:Infectious Disease Threats|Infectious Disease Threats]]
**[[Harbor:Ebola|Suspected Ebola protocol]]
* Environmental Exposure:
** Ask Hazmat Response team or Incident Commander what decon has occurred on scene
** [https://www.atsdr.cdc.gov/toxprofiledocs/index.html CDC Tox Profile Lookup]
 
==Resident Education==
*[[Harbor:Teaching Rounds Topics|Teaching Rounds Topics]]
*[[Harbor:VA MICU rotation|VA MICU rotation]]
*[[Harbor:How to get started in research at Harbor|How to get started in research at Harbor]]
*[[Harbor:Jeopardy Policy|Jeopardy Policy]]
 
==See Also==
{{Special:Prefixindex/Harbor |hideredirects=1}}


[[Category:Admin]]
[[Category:Admin]]

Latest revision as of 01:34, 8 January 2026

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

Admin Updates

Frequently Utilized Resources

  • Asthma (for QIP): Symbicort preferred (formeterol – long-acting B-agonist + budesonide – inhaled corticosteroid), 2nd line is Advair (salmeterol + fluticasone); be sure to refill their controller medication AND the albuterol (if needed). We fall out if they fill more albuterol Rx’s in a year than their controller medication. If prescribing albuterol, do not give refills (you get 200 puffs!).
  • Patient Relations Representatives (PRR) 3p-2a, 7days a week – call Registration for PRR who can help empanel into DHS or change empanelment/network in real time in the ED. PRR can come to bedside to meet with patient or send patient to Registration Windows. During business hours, send patient to Patient Relations Office in Rm 1-B-1.

Triage/RME/Surge Team

Specialty Care/Consults



Disposition



Diagnostics

  • Synapse got a new look. See link for details. A one-page intro guide are available on DHS SharePoint
    • Alt+C still works to compare studies.
    • Open the PowerJacket (folder icons) and then you can pull up the read on 'reports'. Click the dropdown to switch from 'report' to 'notes' to find a free text prelim read.
    • Change your default settings to what PowerJacket looks like and select ‘Notes’ and ‘Reports’ to always open so you can see prelim and final reads, respectively.



Legal/Quality Improvement/Safety

  • Safety
    • Active Threat in the ED
      • Situational awareness
        • Stand between door and patient
        • Ensure patient is gowned
        • Be aware of long stethoscope, lanyard, long hair, etc
        • Panic buttons at nursing stations/router
        • Run & scream for help
      • Hospital Codes
        • Gold x111 - combative/agitated patient
        • Gray x64450 - combative/agitated NON-patient
        • Silver x111 - weapon, active shooter, hostage

PED

Welcome to Harbor-UCLA (Orientation)

Old Material


Administrative duties

Administrative resources

Harbor ED policy manual

ED attending on call plan

Harbor Legal

Managing your Patient

General

On shift (PC) Cheat Sheet

Paging consultants

Phone numbers

Radiology directory

Tests & Orders


Radiology

Radiology Hours

[Radiology Directory]

STAT MRI

Interventional Radiology (IR)

  • When discussing the case with IR, the ED provider needs to clarify if the patient will require sedation for the procedure and communicate this plan to the ED bedside nurse
  • Two pathways from the ED:
    • Patient requires sedation for the procedure – they will be recovered in the PACU
      • If patient is being discharged, the patient will be DC’d from PACU
      • If patient is being admitted, the patient will go to their assigned inpatient room or board in the PACU
    • Patient does not require sedation for the procedure
      • They will be returned to the ED after the procedure

US & QPathE

  • QPathE Login link
    • Login using e# and associated password
    • Double-click the exam
    • Click "edit" at the top of the page
    • Enter MRN in the "patient ID" box
    • in "comments" enter trauma FAST
    • Click save at top of screen


Contrast

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

Blood products

Antibiogram

Finding Equipment/DME

ED supplies A-Z

Procedures

Special patient types

Code Activations

Placement patients

Psych Patients, Code Gold, & Exodus

Scheduled dialysis patients in ED

Sexual Assault/STI Exposure (SART)

Occupational Exposure

Harbor Radiation Precautions

NFL Injured Player/Staff Protocol

Substance Use Disorder (SUD) Treatment Options

Infectious Disease Threats

Social Work

Crown Checks

  • Screening L & D patients: If a pregnant person is brought back to the PED for an evaluation, it should be for active labor and the urge to push.
    • If the pregnant person has the urge to push, we are doing a crown check – that is looking to make sure the head is not visible. We are not doing a complete internal exam. If no head is visible and everything else seems okay, we do a quick MSE note and the patient is sent upstairs to L & D after the nurses call up and let them know they are coming up.
    • Caveats:
      • If the pregnant person is having contractions and the baby appears to be premature below 37 weeks (especially less than 32 weeks) and delivery seems to be imminent (water broke, contractions very close together, etc) consider calling OB batch as the baby can be born through only a partially dilated cervix with little pushing. We do not want this to happen in the elevator.
      • If the birthing person has had multiple pregnancies/deliveries, the baby can be born rather quickly; be more conservative in your clinical judgement to transfer to OB.
      • Vaginal bleeding – if the birthing person is having significant vaginal bleeding, then OB should be called down to us for evaluation – using the OB batch pager gets them down quickly.
      • Please use your medical knowledge to determine the risk to the birthing person and the chances the baby could be born in the elevator. If in doubt call OB batch page for OB to come down to evaluate the situation (I frequently have them come down for micropremies to check to see how imminent delivery is rather than sending upstairs with the risk of delivering in the elevator).

Patients requiring ED D&C

  • If an ED patient requires a dilation and curettage (D&C) for indications such as spontaneous miscarriage or retained products of conception, it can be performed in the adult or pediatric ED’s in collaboration with the OB/GYN team. Once the patient has been consented by the OB/GYN team, they can administer a bedside paracervical block and provide additional analgesia within their scope of practice. If the patient requires (or requests) procedural sedation to facilitate the procedure, this should be discussed with the ED Attending. The ED Attending will determine whether procedural sedation is feasible based on the ED team's capacity and the current state of the department.
  • The estimated sedation time may vary based on the clinical situation, but it is generally expected to be 10-15 minutes. If adequate sedation or analgesia cannot be provided by OB/GYN at the bedside, the ED team is unable to perform procedural sedation, or sedation is expected to take >20 minutes, the procedure should be performed in the operating room with Anesthesia. All decisions regarding the location of the D&C should be patient-centered and involve direct communication between the attending physicians.
  • For elective abortions, have the patient call 1-877-CARE121 8am-5pm M-F and provide patient handout "Pregnancy Options" under Custom Patient education.

Patient Disposition

Discharge

ED Follow-Up Options

DC with meds in ED

  • Eye drops (vanco & tobra) and STI prophylaxis for home
  • HIV prophylaxis for sexual assault patients (raltegravir and Truvada)


Transportation Needs

Social EM resources

Admission

Admission Guidelines

Interqual Criteria Tips

Interqual Override Notes

Right level of care

Neuro Obs & RLA Transfers

OBS & CORE


Dialysis in the ED

Other Disposition

Documentation

Disaster & Surge

Resident Education

See Also

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