Harbor:Neuro Obs & RLA Transfers - Revision history

Bchap23 at 18:01, 20 July 2025

2025-07-20T18:01:42Z

← Revisión anterior		Revisión del 18:01 20 jul 2025
Línea 39:		Línea 39:
	**** Place admission orders including “Admit to Inpatient” order		**** Place admission orders including “Admit to Inpatient” order

			*** '''If appropriate for transfer to RLA:'''
			**** Notify ED to “Place in Obs” (instead of “Request for Admit” as the official transfer of care to Neuro team) and place all orders except “Admit to Inpatient”

	~~• If appropriate~~ for ~~transfer~~ to RLA:		*** OOP Authorized for admission at HUMC
	~~o Notify ED to “Place in Obs”~~ (~~instead of “Request for Admit” as the official transfer of care~~ to ~~Neuro team~~) ~~and place all orders except~~ “Admit to Inpatient”		**** Neuro resident will call UR (x65093) who will re-contact health plan for specific prior authorization to admit to RLA (due to HUMC capacity constraints)
			**** If denied, admit to HUMC by placing “Admit to Inpatient” order
			**** If approved: same process as DHS Empaneled/Eligible patients (below)

	~~o OOP Authorized~~ for ~~admission at HUMC~~		*** DHS Empaneled/Eligible
	 Neuro resident ~~will call UR~~ (~~x65093~~) ~~who will re~~-~~contact health plan~~ for ~~specific prior authorization~~ to ~~admit~~ to RLA (~~due~~ to HUMC ~~capacity constraints~~)		**** Initiate Transfer Process:
	 If ~~denied~~, ~~admit~~ to HUMC ~~by placing~~ “Admit to Inpatient” order		***** Harbor Neurology contacts RLA Neurologist to discuss case (6:30am – 9pm HUMC Neurology resident calls or Teams messages Rancho Neurology attending (AMION: login RLANRC)
	~~ If approved: same process as DHS Empaneled/Eligible patients (below~~)		****** If transfer denied by RLA neurology, place “Admit to Inpatient” order
			****** If approved for transfer by RLA Neurologist:
			******* Avoid further non-urgent diagnostic testing unless requested by Rancho attending (this delays transfer)
			******* Neuro resident to place holding orders as needed (neuro checks, medications, notify physician parameters, etc.)
			******* Complete EMTALA transfer form
			******* Neuro resident orders, “Consult to Transfer Center” (open 7a-11p)
			******** Need Level of Care, accepting Neurology Attending at RLA, “Neuro RLA” as reason for transfer, patient consented to transfer, HUMC Neuro Resident name and callback number
			******* Transfer Center UM performs administrative functions (bed request, financial screening, relays bed assignment/phone number for nursing sign out and transportation instructions) and will call the Neuro resident back to confirm bed availability.
			******* PFS clears case
			******* Bed assigned by RLA bed control
			******* Transfer Center calls HUMC ED clerk (x65001) to order county trans and provide phone number for RN sign out
			******* Clerk gives sign out phone number to HUMC ED RN
			******* RN to RN sign out
			******* Pt transferred via county trans (BLS)
			****** If the transfer has not occurred within 24 hours of the “Place in Obs” order, the patient should be admitted to HUMC (place the “Admit to Inpatient” order with plan for lateral transfer from the inpatient unit whenever a bed is available)

	~~o DHS Empaneled/Eligible~~
	~~ Initiate Transfer Process:~~
	~~ Harbor Neurology contacts RLA Neurologist to discuss case (6:30am – 9pm HUMC Neurology resident calls or Teams messages Rancho Neurology attending (AMION: login RLANRC)~~
	~~• If transfer denied by RLA neurology, place “Admit to Inpatient” order~~
	~~• If approved for transfer by RLA Neurologist:~~
	~~o Avoid further non-urgent diagnostic testing unless requested by Rancho attending (this delays transfer)~~
	~~o Neuro resident to place holding orders as needed (neuro checks, medications, notify physician parameters, etc.)~~
	~~o Complete EMTALA transfer form~~
	~~o Neuro resident orders, “Consult to Transfer Center” (open 7a-11p)~~
	~~ Need Level of Care, accepting Neurology Attending at RLA, “Neuro RLA” as reason for transfer, patient consented to transfer, HUMC Neuro Resident name and callback number~~
	o Transfer Center UM performs administrative functions (bed request, financial screening, relays bed assignment/phone number for nursing sign out and transportation instructions) and will call the Neuro resident back to confirm bed availability.
	~~ PFS clears case~~
	~~ Bed assigned by RLA bed control~~
	~~ Transfer Center calls HUMC ED clerk (x65001) to order county trans and provide phone number for RN sign out~~
	~~ Clerk gives sign out phone number to HUMC ED RN~~
	~~ RN to RN sign out~~
	~~ Pt transferred via county trans (BLS)~~
	 If the transfer has not occurred within 24 hours of the “Place in Obs” order, the patient should be admitted to HUMC (place the “Admit to Inpatient” order with plan for lateral transfer from the inpatient unit whenever a bed is available)

			* FYI
			** Services Available at Rancho
	FYI		*** Medicine: Cardiology (includes TEE, pacemaker), General Medicine/Family Medicine, ICU, Infectious Disease, Pulmonary, Nephrology (includes hemodialysis, peritoneal dialysis, catheter placement), Rheumatology
			*** Surgical: Non-urgent Neurosurgery, Hand Surgery, Orthopedic Surgery, Otolaryngology (includes tracheostomy placement), Plastic Surgery, Spine Surgery, Urology Other: Dental, Optometry/Neuro-optometry, Interventional Pain, PM&R, Psychiatry, Psychology
	• Services Available at Rancho		*** Services Available on Part-Time Basis at Rancho
	o Medicine: Cardiology (includes TEE, pacemaker), General Medicine/Family Medicine, ICU, Infectious Disease, Pulmonary, Nephrology (includes hemodialysis, peritoneal dialysis, catheter placement), Rheumatology		*** Dermatology, GI (includes PEG placement and non-emergent scopes), Gynecology, Vascular Surgery (includes IVC filter, lower extremity IR procedures)
	o Surgical: Non-urgent Neurosurgery, Hand Surgery, Orthopedic Surgery, Otolaryngology (includes tracheostomy placement), Plastic Surgery, Spine Surgery, Urology Other: Dental, Optometry/Neuro-optometry, Interventional Pain, PM&R, Psychiatry, Psychology		*** Neuro-Related Procedures Available at Rancho
	• Services Available on Part-Time Basis at Rancho		*** IVIg, PLEX, Rituximab infusion, Continuous Video-EEG, EMG/NCS, IR-guided LP, PEG placement, trach placement
	o Dermatology, GI (includes PEG placement and non-emergent scopes), Gynecology, Vascular Surgery (includes IVC filter, lower extremity IR procedures)
	• Neuro-Related Procedures Available at Rancho
	o IVIg, PLEX, Rituximab infusion, Continuous Video-EEG, EMG/NCS, IR-guided LP, PEG placement, trach placement

Bchap23 at 17:54, 20 July 2025

2025-07-20T17:54:32Z

@@ Línea 7: / Línea 7: @@
 *<big>'''Harbor to Rancho Neuro Transfer Process'''</big>
-*'''ED'''
+**'''ED'''
-** Patient identified as neuro patient requiring admission
+*** Patient identified as neuro patient requiring admission
-*** IQ request/UM Teams chat
+**** IQ request/UM Teams chat
-**** If stable and OOP, initiate transfer to home health network
+***** If stable and OOP, initiate transfer to home health network
-**** If approved for admission at Harbor, Orchid consult to neuro team
+***** If approved for admission at Harbor, Orchid consult to neuro team
 •	If appropriate for transfer to RLA:

Bchap23 at 15:48, 17 July 2025

2025-07-17T15:48:30Z

← Revisión anterior		Revisión del 15:48 17 jul 2025
Línea 1:		Línea 1:
	*<big>'''Neuro Obs'''</big>		*<big>'''Neuro Obs'''</big>
	** Most frequently utilized for possible stroke (>24 hour onset) with negative CT pending MRI (complex migraine, vestibular syndromes)		** Most frequently utilized for possible stroke (>24 hour onset) with negative CT pending MRI (complex migraine, vestibular syndromes)
	** ~~Notify~~ ED to “Place in Obs” (instead of “Request for Admit” as the official transfer of care to Neuro team)		** Neuro should notify '''ED to “Place in Obs”''' (instead of “Request for Admit” as the official transfer of care to Neuro team)
	** ~~Place~~ all orders except “Admit to Inpatient”		** Neuro will place all orders except “Admit to Inpatient”
	** Within 24 hours of “Place in Obs” order, decision must be made to admit or discharge		*** Within 24 hours of “Place in Obs” order, decision must be made to admit or discharge


	*<big>'''Harbor to Rancho Neuro Transfer Process'''</big>		*<big>'''Harbor to Rancho Neuro Transfer Process'''</big>
			*'''ED'''
			** Patient identified as neuro patient requiring admission
			*** IQ request/UM Teams chat
			**** If stable and OOP, initiate transfer to home health network
			**** If approved for admission at Harbor, Orchid consult to neuro team

	*<big>'''ED'''</big>		<big>'''Neuro'''</big>
	** Patient identified as neuro patient requiring admission
	~~o IQ request/UM Teams chat~~
	~~ If stable and OOP, initiate transfer to home health network~~
	~~ If approved for admission at Harbor, Orchid consult to neuro team~~
	• <big>'''Neuro'''</big>
	o Staff case with senior resident or attending to ensure appropriate for potential transfer (vs admission)		o Staff case with senior resident or attending to ensure appropriate for potential transfer (vs admission)
	o Potential Transfer Diagnoses:		o Potential Transfer Diagnoses:

Bchap23 at 15:41, 17 July 2025

2025-07-17T15:41:09Z

@@ Línea 1: / Línea 1: @@
-o	Most frequently utilized for possible stroke (>24 hour onset) with negative CT pending MRI (complex migraine, vestibular syndromes)
+*<big>'''Neuro Obs'''</big>
-o	Notify ED to “Place in Obs” (instead of “Request for Admit” as the official transfer of care to Neuro team)
+** Most frequently utilized for possible stroke (>24 hour onset) with negative CT pending MRI (complex migraine, vestibular syndromes)
-o	Place all orders except “Admit to Inpatient”
+** Notify ED to “Place in Obs” (instead of “Request for Admit” as the official transfer of care to Neuro team)
-o	Within 24 hours of “Place in Obs” order, decision must be made to admit or discharge
+** Place all orders except “Admit to Inpatient”

Bchap23: Created page with "o Most frequently utilized for possible stroke (>24 hour onset) with negative CT pending MRI (complex migraine, vestibular syndromes) o Notify ED to “Place in Obs” (instead of “Request for Admit” as the official transfer of care to Neuro team) o Place all orders except “Admit to Inpatient” o Within 24 hours of “Place in Obs” order, decision must be made to admit or discharge"

2025-07-17T15:31:09Z

Created page with "o Most frequently utilized for possible stroke (>24 hour onset) with negative CT pending MRI (complex migraine, vestibular syndromes) o Notify ED to “Place in Obs” (instead of “Request for Admit” as the official transfer of care to Neuro team) o Place all orders except “Admit to Inpatient” o Within 24 hours of “Place in Obs” order, decision must be made to admit or discharge"

Página nueva

o Most frequently utilized for possible stroke (>24 hour onset) with negative CT pending MRI (complex migraine, vestibular syndromes)
o Notify ED to “Place in Obs” (instead of “Request for Admit” as the official transfer of care to Neuro team)
o Place all orders except “Admit to Inpatient”
o Within 24 hours of “Place in Obs” order, decision must be made to admit or discharge