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Contents

• PRE-HOSPITAL/SURGE PLANS
  • INTERNAL/EXTERNAL DISASTERS
    • Closing to EMS (ALS) Ambulances
    • Surge Plan
    • DISASTER INSTRUCTIONS
  • ORCHID Downtime
  • Infectious Disease Threats
    • Hepatitis A
    • Flu/ILI
    • Harbor Ebola Precautions
  • EMS: Screening Ambulance Patients
• LABS

2.1 iSTAT Tests 2.2 Coagucheck 2.3 RSV/Influenza PCR 2.4 BIOFIRE TESTS 2.5 Stool Culture 2.6 Lab 2.7 Critical Lab/Radiology Results Callback 3 Radiology 3.1 Formal US in the ED 3.2 Rules for Performing ED Ultrasounds 3.3 CT Scanner Specs 3.4 STAT MRI's 3.5 Discrepancy Review Process 3.6 Discrepancy E-mail 4 Other Testing 4.1 ECG STEMI screening 4.2 Occupational Exposure 4.3 Non-Occupational Exposure 4.4 INDUSTRIAL OR ON-THE-JOB ACCIDENTS (IA) FOR HARBOR EMPLOYEES 5 EQUIPMENT 5.1 Equipment Locations 5.2 Equipment Issues 5.3 4. Durable Medical Equipment (DME) 5.3.1 walkers 5.3.2 wheelchairs 5.3.3 other DME 5.3.4 TLSO Braces 5.4 New iCare 6 OBSERVATION/CORE 6.1 Observation Placement Guidelines 6.2 CORE 7 ADMISSIONS 7.1 RIGHT LEVEL of CARE 7.2 Admitting a Patient 8 Admission and Consultation Rules 8.1 Surgical or Subspecialty Patients with Medical Co-morbidities 8.2 Aortic Aneurysms 8.3 Brain Death 8.4 Breast abscess/mastitis 8.5 Breast mass/malignancy 8.6 Burns 8.7 Cardiology 8.8 Cellulitis(Non-maxillofacial) 8.9 Dialysis fistula/graft problem (e.g. bleeding or thrombosed 8.10 Decubitus Ulcers 8.11 Deep venous thrombosis 8.12 Delirium/Dementia 8.13 GI Bleeding 8.14 Hand Injuries 8.15 Intracranial mass lesions 8.16 Lower back pain 8.17 Maxillofacial trauma 8.18 Maxillofacial infections 8.19 Meningitis 8.20 Osteomyelitis requiring admission 8.21 Painless Jaundice 8.22 Pancreatitis 8.23 Pyelonephritis 8.24 ROSC (Approved by the Chairs of IM and EM 5/1/16) 8.25 Septic Arthritis 8.26 Spinal Injuries 8.27 Stroke 8.28 Thyroid Masses 8.29 Trauma patients 8.30 Vaginal Bleeding 9 References 9.1 Orders on Admitted Patients 9.2 Boarding Patients Sent from Clinic 9.3 Direct Admission after Hours 9.4 Insurance Problems 10 TRANSFERS 10.1 TRANSFERS - INCOMING 10.2 Responding to a Helicopter Landing 10.3 Clinic Referrals to ED 10.4 Guidelines for Flow of patients between the Psychiatric and Adult Emergency Departments (ED Policy 3.4) 10.5 TRANSFERS - OUTGOING 11 FOLLOW-UP 11.1 Summary 11.1.1 REFER TO ED follow up flow chart 11.2 DHS Patient with Empanelled Provider 11.3 Urgent <2 Week Specialty Follow-up for DHS or MHLA Patients 11.4 Discharging Patients Direct to Specialty Clinic 11.5 Follow up in CCC 11.6 Follow up MAT/Buprenorphine/Opiate Withdrawal Treatment 11.6.1 REFER TO MAT Pathway File:Harbor UCLA ED Bup DH 11-28-18 Final.pdf 11.6.2 Patient Discharge Handout File:Bup Start (Harbor).pdf 11.6.3 Patient MAT/Buprenorphine Follow Up Options 11.7 Follow up In Other Clinics 11.7.1 Anticoagulation (Coumadin) Clinic 11.7.2 Breast Diagnostic Center (Radiology) 11.7.3 Breast Surgery Clinic 11.7.4 CARDIOLOGY 11.7.5 DERM 11.7.6 ENT 11.7.7 Expedited Work-up Clinic (EWC) 11.7.8 GYN 11.7.9 Gyn UCC 11.7.10 Nephrology Clinic 11.7.11 Neurosurgery 11.7.12 OB 11.7.13 ONCOLOGY 11.7.14 OPHTHO 11.7.15 ORTHO 11.7.16 PEDIATRICS 11.7.17 Pediatric Adolescent Clinic 11.7.18 Pediatric Cardiology 11.7.19 PLASTIC SURGERY 11.7.20 PULMONARY 11.7.21 RHEUM 11.7.22 SURGERY 11.7.23 UROLOGY 11.7.24 72 HRS STRESS TEST 11.8 FOLLOW-UP FOR OUT-OF-COUNTY/OUT-OF-COUNTRY (OOC) PATIENTS 12 Physicians 12.1 Important Numbers 12.2 Printable FORMS 12.3 PC CHEAT SHEET 12.4 Contacting the Attending On-Call/Problems with On-Call Physicians 12.5 On Call Plan - Emergency Department Attending Physicians 12.6 Trauma Activations 12.7 STEMI Activations 12.8 CODE STROKE 12.9 Scheduled Dialysis Patients in ED 12.10 Attending Documentation 12.10.1 Minimum Content for Attending Notes 12.11 Resident Documentation 12.12 E-Prescribing 12.13 CODES 12.13.1 CODE ASSIST 12.13.2 CODE BLUE 12.13.3 CODE WHITE 12.14 CODE GREEN See "LEGAL" 12.15 CODE GOLD See "LEGAL" 12.15.1 AIRWAY MANAGEMENT TEAM 12.15.1.1 Airway Coverage Times 12.15.1.2 Documentation 12.16 Templates 13 RME/TRIAGE 13.1 RME Phones 13.2 RME Patient Flow 13.3 FastTrack 13.4 Triaging Clinic Patients 13.5 Direct to Back 13.6 Criteria for an immediate transfer to Chest Pain Room 13.7 ECG Screening by Providers 13.8 Patient Transfers to other areas of the hospital 13.8.1 Psych ED 13.8.2 Gyn UCC 13.8.3 Urgent Care 13.8.3.1 Transfer of Low Acuity Patients from ED to UCC 13.8.3.2 Pausing Patient Flow from ED to UCC 13.8.3.3 Transfer of Patients from UCC to ED 13.9 FastTrack Roles 13.10 NP Independent Workup Guidelines 13.11 Being Seen by Consultants Prior to ED Evaluation 13.12 NP Consultation Guidelines 13.13 NP Consultation with the Attending Physician 13.14 NP Independent Discharge Guidelines 13.15 Rapid Discharge Procedure 13.16 RIPT 13.17 Discharge to Chairs 13.18 LBTC FOLLOW-UPS 14 LEGAL 14.1 INVOLUNTARY HOLDS, CODE GOLD, COLD GREEN 14.2 Mandatory Reporting of Adverse Events 14.3 Prescriptions 14.3.1 Lost Triplicate Prescriptions 14.3.2 Safe Pain Medication Prescribing Guidelines 14.4 Family Viewing of Deceased Patients 14.5 Law Enforcement Escorting Patients Out Of the Emergency Department 14.6 Weapons in ED 14.7 ILLICIT DRUGS/MARIJUANA IN ED 14.8 OBSERVERS IN THE ED 15 Social Work 15.1 Social Work Consultation Guidelines 15.1.1 1. SW Order Indications 15.1.1.1 Lack of Resources 15.1.1.2 Poor judgement/Substance Abuse 15.1.1.3 Psychosocial Support 15.1.1.4 Regulatory/Legal Issues 15.1.1.5 Nonspecific 15.1.2 2. Transportation home: 15.1.3 3. Patient who are homeless: 15.1.4 5. Patients whom family is no longer able to take care of 15.1.5 6. Pt/family not happy with current skilled nursing facility (SNF) 15.1.6 7. Clothing rack / clothing for patients 15.1.7 8. Patients who need PT/OT for placement 15.2 Whole Person Care 16 Core Measures 16.1 SEPSIS Core Measure Guidelines 16.2 Sepsis Abx 17 HARBOR ED POLICY MANUAL 17.1 Home Page → Policies and Procedures → HUMC → HUMC Policies and Procedures 17.2 3.0 Admissions and Consultations 17.3 21.3 Respiratory Isolation Patient Protocol[1] 17.4 21.4 Care of Potential Myocardial Ischemia Patient in Triage 17.5 21.5 Medications in Triage: Standardized Procedure 17.6 Consent 18 See Also 19 References