Harbor:Main: Difference between revisions
 
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==Admin Updates==
==Admin Updates==
* Newsletter  
* Newsletter  
** [https://harbor-ucla-ed-newslette-bnaeoyf.gamma.site/ The Newsletter: Shorter + Mobile Friendly Version]
** [https://harbor-ucla-ed-t7sies2.gamma.site/ The Newsletter: Shorter + Mobile & Desktop Friendly Version]
** [https://lacounty.sharepoint.com/:w:/t/EDOperations-HUCLA/EZPD3xa9jFxFoPEq3F9Y1jYBpMM48jQQMEQl7VFz8nmq-A?e=wg1Gdl The Full Newsletter: Word Doc]
** [https://lacounty.sharepoint.com/:w:/t/EDOperations-HUCLA/IQBUmapSQpzbR58_p7oa04d3AfmdWb0SBGZt4ND0Q6Wd4Mo?e=rEbPc8 The Full Newsletter: Word Doc]


*New!  
*New!  
** [[Harbor: Surge Team Checklist|Surge Team Checklist]]
** [[Harbor:Sepsis_core_measures|Sepsis Core Measure (SEP-1) Tips]]
** [[Harbor:_ED_to_UCC#ED_to_UCC|ED to UCC (11-12-2025)]]
** [[Harbor:OOP_follow_up_options|OOP Urgent Specialty Referral Process 8-18-2025]]
** [[Harbor:OOP_follow_up_options|OOP Urgent Specialty Referral Process 8-18-2025]]
** [[Harbor:Legal#Law_Enforcement_in_the_ED|Law Enforcement in the ED (ICE)]]
** [[Harbor: ED ECMO|Harbor ED ECMO]]
** [[User_talk:Bchap23#Surge_Team|Surge Team Checklist]]
** [[Joint_Commission_(JC)_Readiness|Joint Commission (JC) Readiness]]
** [[Joint_Commission_(JC)_Readiness|Joint Commission (JC) Readiness]]
==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]
* 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]]
** [[Harbor:Interqual_Criteria_Tips|InterQual Criteria]]


* QR
*Obs
**[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]
** [https://wikem.org/wiki/Harbor:Placement_patients Placement Patients]
** [[Harbor:Neuro Obs & RLA Transfers|Harbor Neuro Obs & RLA Transfers]]


* Admits & Obs
* Admits  
** [[Harbor:Admission_and_consultation_guidelines|Admission Guidelines]]
** [[Harbor:Admission_and_consultation_guidelines|Admission Guidelines]]
** [[Harbor:Right_level_of_care|Right Level of Care]]
** [[Harbor:Right_level_of_care|Right Level of Care]]
** [https://wikem.org/wiki/Harbor:Placement_patients Placement Patients]
** [[Harbor:Neuro Obs & RLA Transfers|Harbor Neuro Obs & RLA Transfers]]
** [[Harbor:Direct_Admission_after_Hours|Direct Admissions and Admissions from Clinic How-to Guide]]
** [[Harbor:Direct_Admission_after_Hours|Direct Admissions and Admissions from Clinic How-to Guide]]
**[[Harbor:Direct Admission after Hours]]


* Transfers
* Transfers
** [[Harbor:Main#Transferring_a_patient|Transfers - Re-plant, Burns, Stroke, STEMI, Hyperbaric, L&D, Psych/Exodus]]
** [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]
** [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
* Discharges
** [[Harbor:ED_follow-up_options|Discharging to Clinics]]
** [[Harbor:ED_follow-up_options|Discharging to Clinics]]
** [https://lacounty.sharepoint.com/:w:/s/medicineoutpatientspecialtycare/ESLCad7IJDxCjklxFLNfWwIB1hRf_HGr2t2n8u6MvqNHfw?e=4%3AFvJCKk&fromShare=true ED to Specialty Clinic DC - please check instructions for each specific clinic prior to making an appointment]
** [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]
** [https://wikem.org/wiki/Harbor:Expedited_Work-up_Clinic_(EWC) Expedited Workup Clinic]
*** [[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/Template:Harbor_Admission_Guidelines#Breast_abscess.2Fmastitis Breast Abscess]
** [https://www.wikem.org/wiki/Harbor:Admission_and_consultation_guidelines#Breast_mass.2Fmalignancy Breast Mass]
** [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:ED_follow-up_options#BURN_CENTER_CLINIC|July 4th - Outpatient USC Burn Center Follow-up]]
** [[Harbor:_Social_Discharges|Social Discharge Options]]


* Ortho
==Diagnostics==
** [https://lacounty.sharepoint.com/:w:/t/EDOperations-HUCLA/ES3s8sXJdKBLpukbDXsHZfoBwhQCS17ogqrR8mC2TVNvcQ?e=xp82nc Ortho Consult Criteria]
* MRI [[Harbor:STAT_MRI|Ordering a MRI]]
** [https://wikem.org/wiki/Harbor:ED_follow-up_options#ORTHO Ortho:  Splint vs Consult]


* 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]
**[[Harbor:STAT_MRI|Ordering a MRI]]
**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.


* 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]


*OLD TOPICS
** [[Harbor:Surge_plan|Surge Criteria/Plan]]
** [https://dhs.lacounty.gov/harbor-ucla-medical-center/work-or-partner-with-us/la-drop/ LA Drop (Prehospital Blood)]
** [[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]
** [https://ucop.app.box.com/s/0797on829mptrfhuooqxy15z7l91z3dt UCLA:  POTUS Executive Order Tracker]


*New Expedited Work up Clinic referral process: https://www.wikem.org/wiki/Harbor:Expedited_Work-up_Clinic_(EWC)
*New asthma guidelines
**The preferred DHS controller medication is Symbicort (formeterol – long-acting B-agonist + budesonide – inhaled corticosteroid), 2nd line is Advair (salmeterol + fluticasone). 
**If seeing the patient in the ED for an asthma exacerbation, please 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, so we need to make sure they get both when seen in the ED.  If prescribing albuterol, do not give refills (you get 200 puffs!).
*Sepsis – remember to do the required components of the sepsis core measure w/in 3 hrs (30ml/kg, bcx, abx), document using the auto text (use “auto text copy utility” to get Brad Chappell’s “ .harsepsis” to go through the reminder guidance text and exclusions for IVF 30ml/kg. Communicate to the admitting team if they need to repeat the lactate and perform the sepsis reassessment exam with time stamp (w/in 6 hrs). 
*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. 


*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]
==Legal/Quality Improvement/Safety==
**Alt+C still works to compare studies.
* Legal
**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.
** [[Harbor:Legal#Law_Enforcement_in_the_ED|Law Enforcement in the ED (ICE)]]
**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.
*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.


* '''Harbor's COVID page''' [[Harbor:Infectious_Disease_Threats#Wuhan_Coronavirus_.28nCoV-2019.29|Coronavirus (COVID-19) Info]]
* QI Projects
** Paxlovid, Remdesivir, etc ... [[Harbor:Infectious_Disease_Threats#Treatment|COVID Treatment Options]]
**[[Harbor:Core Measures|Core Measures]]
** [https://dhs.lacounty.gov/harbor-ucla-medical-center/work-or-partner-with-us/la-drop/ LA Drop (Prehospital Blood)]


* '''Interqual criteria''' [[Harbor:Interqual_Criteria_Tips|Interqual Criteria Tips]]
*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


* '''Monkeypox'''
==[[Harbor:Pediatric_ED_(main)|PED]]==
** 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]


**[[Harbor:Crown Checks in PED|Crown Checks in PED]]


* '''Active Threat in the ED'''
==Welcome to Harbor-UCLA (Orientation)==
** Situational awareness
*[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]
*** Stand between door and patient
**[[Harbor: Macros and Autotext|Macros and Autotext]]
*** Ensure patient is gowned
*[[Harbor:Attending documentation|Attending Documentation]]
*** Be aware of long stethoscope, lanyard, long hair, etc
*[[Harbor:Resident documentation|Resident documentation]]
*** 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


==General Administrative==
==Old Material==
*Pre-hospital
*Pre-hospital
**[[Harbor:Incoming transfers|Incoming transfers]]
**[[Harbor:Incoming transfers|Incoming transfers]]
Line 100: Line 142:
* [[Harbor:Resident responsibilities and transitions of responsibility|Resident Responsibilities]]
* [[Harbor:Resident responsibilities and transitions of responsibility|Resident Responsibilities]]


===[[Harbor:Screening EMS Patients|Ambulance (EMS) Triage]]===


===Administrative duties===
===Administrative duties===
Line 111: Line 152:


===Administrative resources===
===Administrative resources===
===[[Harbor:RME & TRIAGE|RME & triage]]===
**[[Harbor:Direct Admission after Hours]]
**[[Harbor:Core Measures|Core Measures]]
**[[Harbor:Crown Checks in PED|Crown Checks in PED]]
===[[Harbor:ED policy manual|Harbor ED policy manual]]===
===[[Harbor:ED policy manual|Harbor ED policy manual]]===
===[[Harbor:ED attending on call plan|ED attending on call plan]]===
===[[Harbor:ED attending on call plan|ED attending on call plan]]===
Line 126: Line 162:


====[[Harbor:Paging|Paging consultants]]====
====[[Harbor:Paging|Paging consultants]]====
*[[Harbor:Ophtho abbreviation dictionary]]
 
====[[Harbor:Phone numbers|Phone numbers]]====
====[[Harbor:Phone numbers|Phone numbers]]====
====[[Harbor:Radiology directory|Radiology directory]]====
====[[Harbor:Radiology directory|Radiology directory]]====
Line 299: Line 335:
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
*'''[[Harbor:Death Packet Checklist|Death Packet Checklist]]
* [[Harbor:Deceased patients|Deceased patients]]
* [[Harbor:Deceased patients|Deceased patients]]
===[[Harbor:Transferring a patient|Transferring a patient]]===
==Documentation==
*[[Harbor:Transferring to psych ER|Transferring to psych ER]]
*[[Harbor:Exodus|Exodus Psych transfers]]
*[[Harbor:Transfer to L&D|Transfer to L&D]]
*[[Harbor:Transfer/Discharge to Specialty Clinic|Transfer/Discharge to Specialty Clinic]]
*[[Harbor:911 STEMI out|911 STEMI out]]
*[[Harbor:MAC Transfer Burn or Replant|MAC Transfer Burn or Replant]]
*[[Harbor:Replantation_Patients|Hand Replant]]
*[[Harbor:Transfer to Comprehensive Stroke Center|Transfer to Comprehensive Stroke Center]]
*[[Harbor:XRT|XRT transfers]]
*[[Harbor:_Hyperbaric_Transfers|Harbor: Hyperbaric Transfers]]


==Documentation==
*[[Harbor:PC Cheat Sheet|PC Cheat Sheet]]
**[[Harbor: Macros and Autotext|Macros and Autotext]]
*[[Harbor:Attending documentation|Attending Documentation]]
*[[Harbor:Resident documentation|Resident documentation]]
*[[Harbor:Consenting a patient|Consenting a Patient]]
*[[Harbor:Consenting a patient|Consenting a Patient]]
**[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]
**[[File:Harbor-Photo-Consent.pdf|Photo Consent Form]]

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

Retrieved from "https://www.wikem.org/w/index.php?title=Harbor:Main&oldid=380941"