Harbor:Main

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

Admin Updates

  • When discharging Homeless patients but still waiting for Social Work:
    • ED Provider drop house and fill out the Homeless Discharge Form in the depart process (offered a meal, Hep A or COVID vaccines, weather appropriate clothing, outpatient medical and/or mental health resources, prescriptions, etc.)
    • ED RN: discharges and departs patient off the track, places a patient sticker on a paper log at the Router Desk for SW/HTF
    • SW/HTF will assess patient, explore placement opportunities and give resources as available for patient.


  • StatRad Hours
    • All studies Fri 4p-Mon 8a and county holidays with expected TAT<4 hrs
      • Code Strokes after 4p daily
      • Available 24/7 as-needed - ED attending call radiology resident (p5814) to request StatRad read



  • COVID VACCINES AVAILABLE to ALL PATIENTS 12 and older with ORCHID MRN:


  • No CCC for specialty e-consult
    • DHS: message PCP for anything urgent
    • OOP: return to PCP
    • NOT EMPANELED DHS ELIGIBLE: NERF for PCP who can submit e-consult
    • CCC: still available for non-empaneled DHS eligible patients with urgent follow-up needs (eg., uncontrolled DM)
    • Goal: Reduce number of CCC referrals solely for e-consults to ZERO by September 2021


  1. Determine if the child needs to be admitted to our hospital ( if being transferred we should not do the test ). This is for all patients being admitted to pediatrics ward, sdu, PICU, NICU, nursery.
  2. If parent unvaccinated and want a covid test they will be registered and insurance info documented in the PED by registration. Any symptomatic parent will not be allowed upstairs.
  3. Parents can be told we will bill insurance but they will not be responsible for copay or deductible.
  4. Provider will do an MSE note stating the parent is being seen only to get a Covid test so they can accompany their child upstairs for admission. MSE note sample: Mrs. X is a 35 yo woman unvaccinated for covid. Her child is being admitted to Harbor UCLA pediatric department. Mrs. X is only be seen for a covid test so she can accompany her child during their admission.
  5. Covid test will be ordered and done as an Admitted asymptomatic test.
  6. No vital signs or other exam will be done on the parent or guardian. If they request it be done they will be seen and billed as a full ED visit.
  7. This will be offered for only one parent or guardian.
  8. The parent can wait in PED waiting room if the child is moved upstairs prior to their Covid test resulting.
  9. If Covid test + parent or guardian will not be allowed upstairs with their child. If the Covid test is + but it has been greater than 10 days since a previous covid test they can still accompany their child on admission.
  10. Once the Covid test results parents will be told their Covid result and they will be discharged. If neg they may go upstairs to be with their admitted child. If + they can not go upstairs unless it has been greater than 10 days since their last + covid test.
  • Please call Dr. Padlipsky or Dr. Zangwill with any questions or concerns that come up.
  • There is a book with magenta colored rectangles/squares on it labeled Parents Covid tested in PED. This will be kept on top of the safe. Please write down the parents name and MRN and date of the test so we can make sure they are not billed for the visit.


  • STEMI transfer during cath lab remodel
    • 911 IFT - 30 min from door to transfer (unless there happens to be a county ALS unit in our ED ready to go)
    • Clerk fax EKG, copies face sheet and
    • Call LCM Torrance on radio, fill out STEMI transfer out form
    • EMTALA form from patient
    • MICN contact 911
    • If patient on pressors, sedation for vent, antiarrhythmic gtt --> OCN will find RN/MICN to go with pt (and likely Triage/FT or PED resident)

General Administrative

  • Pre-hospital
    • Incoming transfers
    • Exodus Transfers
      • Exodus should call Psych ED about transfer, not Med ED
      • Med ED will do MSE

Screening EMS Patients

Administrative duties

    • Administrative resident directions
    • Receiving Phone Calls
    • EKG Screening
    • Pre-shift: 5S
    • Airway Bag [[1]]
      • Missing or low on equipment such as McGrath blades or batteries - inform the overall charge nurse (more in nursing office)
      • PURPLE SENIOR - use the laminated checklist to stock AT EACH SHIFT CHANGE on on-call days
      • Locks let you know which compartments to check
      • ED pharmacists help with meds BUT SENIORS should double check.
      • TURN OFF McGRATH AFTER USE!
      • Can use new “GlideScope Go” with a MAC 3 & 4 blade, but bring it back. (It’s not part of bag).

Wu 11/2019)

Administrative resources

RME & triage

Harbor ED policy manual

Harbor Legal

Managing your Patient

General

On shift (PC) Cheat Sheet

Paging consultants

Phone numbers

Radiology directory

Tests & Orders

Radiology Hours

    • StatRad
      • All studies Fri 4p-Mon 8a with expected TAT<4 hrs
      • Code Strokes after 4p daily
      • Available 24/7 as-needed - ED attending call radiology resident (p5814) to request StatRad read
      • Reports go directly into FirstNet
      • Faxing prelim during downtime
        • Can also directly login to their website: StatRad --> Main tab --> review exams & images --> can search by name or MRN
          • Call Dr. Chappell for login information
    • Fortino
      • All X-rays M-F 8a-5p
    • Radiology resident
      • Mon – Thursday 4p - 8a
      • Prelim reads on ED CT, US, MRI
      • Call resident for any XR questions overnight (prelim read), otherwise enter an ED PRELIM and Fortino will over-read in the AM
      • For any XR or CT disagreements overnight, the ED attending can request radiology resident send to StatRad for a final attending read
        • The radiology resident will ask for your name and call-back spectralink and push the radiology study to StatRad

Enter Prelim Rads Read

  • Oral contrast
    • No more gastrograffin, replaced by omnipaque. Must place an order for it. If you need to obtain a retrograde urethrogram, order a KUB.
    • Below is the suggested/usual volume of omnipaque used for certain indication sent to us by Dr. Putnam:
      • For use in bowel obstruction, a volume of 100cc of Omnipaque 300 is used.
      • For use in tube contrast studies, a volume anywhere between 50-200cc of Omnipaque 300 would likely be used.
      • For a CT with po contrast, the order is for 30cc of Omnipaque 300 in 970cc of water.

Outpatient IR

  • Interventional Radiology (IR) - outpatient - for items such as stenosed/thrombosed dialysis catheter, etc
    • For DHS/MHLA patients who require an urgent IR procedure, and have no other indication to be admitted, then the patient will be accommodated in the IR schedule to get their procedure done within 24-48 hours as outpatient.
    • ED provider will discuss with the IR resident on call x64747, p5423
      • IR Business hours:
        • If request for outpatient urgent IR procedure happens during the hours that IR clerk is available, then the providers can discuss with IR if the procedure can be done the next day or day after.
        • The ED provider will need to fill out the grey IR paper form which will need to be delivered to IR in 2 West, Room 40 (copies are in the hanging folders in doc boxes)
        • Patient will need CBC, chem 7, POC INR, and COVID test
      • Afterhours:
        • If request is approved by on call IR attending/resident, but the clerk is not there, then the plan should be to do the procedure not the next day, but the day after, to give time to create the appointment and FIN.
        • Fill out the electronic IR Form for after hours and email it to the following:
          • Juliana Castel
          • Shontay Hysaw
          • Anton Mlikotic
        • Subject: ED IR REQUEST
        • The request will be processed at the beginning of the following business day.
        • Patient will be contacted by the IR schedulers for exact appointment time and be told to go to OR second floor surgery registration area to get check in to be registered therefore do not need to come back to ED on the day of procedure.
      • For OOP patients:
        • ED providers can call UM to see if patient can be transferred to in-network hospital, or an urgent appointment with patient's PCP or specialist can be made. If patient's care cannot be safely transferred to in-network, then we can request for an authorization to admit the patient, given that procedure will be done the next day.

STAT MRI

Antibiogram

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

Finding Equipment/DME

E supplies A-Z

Procedures

Special patient types

Whole Person Care

Social Work

Code Activations

Sepsis

Sepsis core measures

Occupational Exposure

Sexual Assault/STI Exposure (SART)

Others

Scheduled dialysis patients in ED

COVID

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

  • BUS/METRO TAP CARDS:
    • 8a-5p - send to Social Work Office
    • Nights/weekends/holidays - ED RN can get from the House Supervisor x65620 or spectra 23721 who will deliver the voucher to the ED
  • TAXI VOUCHERS: Must have a place to go with keys/someone home, or a shelter where patient is already accepted
    • Daytime - call Social Work to facilitate
    • Night/Weekend/Holidays - call house supervisor x65620 or spectra 23721 who will deliver the voucher to the ED
      • RN calls taxi - must notify taxi if needs wheelchair accessibility (Yellow Cab @ 310-533-6800)
      • RN takes the patient to the hospital nursing office; taxi driver comes to nursing office to sign paperwork and pick up the patient
  • UBER/LYFT:
    • Similar to above Taxi Vouchers
    • Available to patient's without insurance who do not have other transportation options
  • AMBULANCE: for patients that have a medical necessity (cannot ambulate, here w/o wheel chair, etc) and medically cannot take a taxi
  • ED RN & area clerk to coordinate with insurance (if applicable)
  • If patient is UNINSURED (including restricted Medi-Cal) - use county transport to get an ambulance home
    • UR & SW can get involved if issues
    • If patient lives outside of LA County, call nursing supervisor or SW as they may need further authorization
      • Joy Lagrone can authorize county transport as a last resort
  • Kids without car seats: For kids who arrive (usually by ambulance) w/o a car seat, we do not have car seats available. however, options are:
  1. Take the bus home (no need for car seat)
  2. Have someone bring a car seat and pick them up or go home in a taxi with the car seat that is brought in
  3. If either of above options is not possible, may try arranging for ambulance (see section above)

Social EM resources

  • Harbor Social Work
    • 24/7 Auto page in house social worker p1735 for various issues including: homelessness, discharge planning, sexual assault, crisis/grief, suspected elder/child abuse, recoup care, disability benefits (SSI), etc.
  • Homeless Task Force, in person during business hours 730a-4p Mon-Fri pager # is (310) 501-0637 and their phone number is (310) 413-8871
  • Opiate Withdrawal/MAT/BUP
  • Medical Legal Partnership
  • Immigration Assistance
  • Hospital Based Violence Intervention Program (HBVIP) and Trauma Recovery Center (TRC)
  • Whole Person Care (WPC) autopage in Cerner (p0145), refer 24/7.
    • Substance Use Disorder (SUD)
      • Available SUD counselor in-person Mon 8a-5p, T-F 8a-12:30a, Sat 4p-12:30a.
      • Otherwise will follow up next business day via phone call. Need good contact phone number. Ensure patient knows you put a referral and someone will be contacting them.
      • On discharge, include the WPC discharge instructions (“Whole Person Care Harbor-UCLA”, also available in Spanish) from ORCHID
    • Medically Complex Transitions of care (includes 3 visits to ED in past year)
      • 1) ORCHID Message/Call/Text Rosario Aliviado - Social Work Supervisor. Please include MRN, pt phone number, and reason for referral. (213) 294-8908. She will respond M-F 9:00-4:30 pm but you can ORCHID message/call/text/email anytime.
      • AND 2) place order in ORCHID "Consult to Whole Person Care". Reason for Consult Freetext: "Substance Abuse", "MAT", or "TOC" and any relevant details.
  • Re-entry (released from prison <6 months with medical, mental health, substance abuse, or social needs) (844) 804-5200 (24/7) and put patient on phone.
  • Food Pharmacy, free fruits and vegetables every Wednesday 9a-1p outside front entrance of S/E building
  • Free cell phones:
    • Lifeline free phones: Outside of PCDC building 8a-6p (Mon-Fri), Wednesday only they outreach in front of the SE building to catch patients participating in the Food Pharmacy program.
    • Social work has a limited number
  • Mental Health
    • Residential & Bridging Care (transition from mental health institution to community) (213) 738-4775
    • Intensive Service Recipients (mental health with 2 or more admissions in year, recent DC from psych hospital) (844) 804-5200
  • Perinatal (high-risk pregnant mothers - homeless, mental health, substance abuse, domestic violence, no food) Mama's Program (844) 376-2627

Admission

Admission Guidelines

Interqual Override Notes

Right level of care

OBS & CORE


Dialysis in the ED

Other Disposition

Documentation

Disaster & Surge

Resident Education

See Also