Harbor:Pediatric ED (main)

See Adult ED for the main adult Harbor page.

Background

This is the main page for Harbor-UCLA Pediatric ED.

General Administrative

• Schedule and sick backup plans
  • Resident shifts: EM, Pediatrics, Med-Peds
    • 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
    • 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
    • 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.
    • Fellows may be scheduled for any of the resident shifts
  • Intern and FM shifts
    • 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
  • Attending shifts
    • There will be 24 hour attending coverage in the PED. The shifts will be 7a-4p, 4p-12mn, and 12mn-7am
  • Teaching rounds
    • Teaching will occur 7a-7:30a, and may occur 4p-4:30p
      • 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
    • Huddle (with nursing) will occur at 7:15a
  • Trading shifts
    • 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
    • EM residents (R2, R3, R4)
      • May trade with other EM residents or PEM fellows
      • May trade a PED shift with an AED shift
        • This will be logged as a switch shift
        • Only R3s, R4s, or PEM fellows can do the overnight shifts
        • EM R3s & R4s may trade overnight shifts only (no other type of shift) with Harbor Peds R3s
    • Pediatric, Med-Peds, and FM residents
      • May trade with each other
      • Only a Harbor Peds R3 can do an overnight (non-Harbor residents will not have the familiarity with Harbor that is needed)
      • Harbor Peds R3s may trade overnight shifts only (no other type of shift) with EM R3s or R4s
      • 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
        • Would expect this would just be one shift though, so it doesn’t overly impact your PED rotation
    • Interns and FM residents
      • Interns may trade with each other or with FM residents scheduled in a 10a-7:30p or 3p-12:30a shift
      • May also get another intern from their program (or any EM or Peds intern) to cover their shift
    • Get your trade approved
      • Trade cannot incur an RRC duty hours violation
      • Send your proposed trade to kyoung@emedharbor.edu AND christiane@emedharbor.edu for review
      • Have BOTH people involved in the trade email to assure that they agree (one person can forward an email in which the other agrees)
      • Do this well in advance so your trade can be properly reviewed
  • Sick Back-up Plans
    • 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
    • Notify Kelly Young at kyoung@emedharbor.edu, Christiane at christiane@emedharbor.edu, AND call the current PED attending at 310-222-6939
      • EM residents contact Madonna Fernandez or the chief residents
      • Peds residents contact your chief resident
      • FM residents contact Theresa Nevarez or your chief residents
      • UCLA Med-Peds residents contact your chief resident
    • If 7a-4:30pm resident is sick
      • Jeopardy coverage for EM residents
      • Coverage from own program for Peds or Med-Peds residents
        • If no coverage available, and PED is very busy, EM jeopardy may be called
      • 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
    • If 4p-1:30am resident is sick
      • Jeopardy coverage for EM residents
      • Coverage from own program for Peds or Med-Peds residents
        • If no coverage available, and PED is very busy, EM jeopardy may be called
      • 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
    • If mn-7:30am resident is sick
      • Jeopardy coverage from own program (EM or Peds)
    • If EM resident is jeopardized, will attempt to arrange payback coverage, including from Peds or UCLA residents
• Follow-up track information
  • Place lab checks for any lab that will not result during the patient's visit
    • Examples: urine/throat/wound cultures, urine GC/Chlamydia, pertussis PCR, thyroid function tests
    • Use the ED Post Visit Plan on the Depart Process
      • Get a phone number where the patient can be reached best
      • Click Lab/Radiology follow-up
      • Specify result to be checked and plan
      • 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)
  • You can order phone f/u calls to check on patient's symptoms
    • Do as for lab check above, except check Symptom Follow-up and specify what symptoms to ask about
  • If a patient can be seen at Harbor (not OOP), you can put in for a referral
    • Do as for lab check above, except check Referral and specify what referral is needed
  • 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
  • Detailed instructions are in a binder labeled "F/U Instructions" in the PED, and on Pemsource.org on the Harbor page

Managing your Patient

Ordering

• Ordering a Formal Ultrasound
• Ultrasound approval list
• Ordering a CT
• Ordering Blood Products
• Ordering antibiotics
  • Harbor antibiogram

Documenting

• Attending documentation
• Consenting a Patient

Procedures

• Equipment
• Consenting a patient

Finding Things

• Paging consults
• Consultation of subspecialists

Patient Disposition

Discharging a Patient

• Prescribing
• Options for follow-up

Admitting a patient

• Paging consultants
• Admission guidelines

Other

• Deceased patients

Disaster

• General disaster info
• Harbor:Surge plan
• Suspected Ebola protocol

See Also

• Harbor:Main
• Harbor:Operations manual