Harbor:Operations manual - Revision history

Rossdonaldson1: Redirected page to Harbor:Main

2019-01-31T05:24:46Z

Redirected page to Harbor:Main

← Revisión anterior		Revisión del 05:24 31 ene 2019
Línea 1:		Línea 1:
	~~==Pre-hospital/Surge Plans==~~		#REDIRECT[[Harbor:Main]]
	~~===[[Harbor:Incoming transfers\|Incoming transfers]]===~~
	~~===Ambulance Triage===~~
	*[[Harbor:Screening EMS Patients\|Screening EMS Patients]]
	~~===Surge Criteria and Plan===~~
	*[[Harbor:Surge Plan/Disasters\|Harbor Surge Plan/Disasters]]
	*[[Harbor:Disaster plan\|Harbor disaster plan]]

	~~===Orchid Downtime===~~
	*[[Harbor:ORCHID Downtime\|ORCHID Downtime]]
	~~===ID: Flu, Hepatitis, Ebola===~~
	*[[Harbor:Infectious Disease Threats\|Infectious Disease Threats]]

	~~==[[Harbor:Labs\|Labs]]==~~

	~~==Radiology==~~
	*[[Harbor:ED Radiology Specs\|MRI Specs]]
	*[[Harbor:ED Radiology Specs\|CT Specs]]
	*[[Harbor:Rules for Performing ED Ultrasounds\|Formal & ED Ultrasounds]]
	*[[Harbor:STAT MRI\|STAT MRI]]
	*[[Harbor:Example text for a discrepancy e-mail\|Example text for a discrepancy e-mail]]

	~~==EQUIPMENT==~~
	*[[Harbor:Equipment\|Equipment (AED/RME)]]
	*[[Harbor:Equipment and supplies (peds)\|Equipment (peds)]]
	~~===Ordering DME===~~
	*[[Harbor:DME\|Durable Medical Equipment (DME)]]

	~~==IA/Exposures==~~
	~~===[[Harbor:Occupational exposure\|Occupational Exposure]]===~~
	*[[Harbor:Industrial Accident (IA)\|Industrial or On-the-Job Accidents (IA)]]
	~~===Sexual Assult/STI Exposure===~~
	*[[Harbor:Non-Occupational Exposure\|Sexual Assult/STI Exposure]]

	~~==Patient Disposition==~~
	~~===F/up Flowchart===~~
	* https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]
	~~===[[Harbor: ED Follow-Up Options\|ED Follow-Up Clinics]]===~~

	~~===[[Harbor:Discharge\|Law Enforcement Escort]]===~~
	*[[Harbor:Prescribing\|Prescribing]]

	~~===Other===~~
	*[[Harbor:Deceased patients\|Deceased patients]]
	*[[Harbor:Transferring a patient\|Transferring a patient]]
	**[[Harbor:Transferring to psych ER\|Transferring to psych ER]]

	~~==ADMISSIONS==~~
	~~===Admission Policy===~~
	*[[Harbor:Admitting a patient\|Admitting a patient]]

	~~=== OBS & CORE===~~
	*[[Harbor:Observation placement\|Observation placement]]
	*[[Harbor:CORE\|CORE placement]]

	~~===Admission Guidelines===~~
	*[[Harbor:Admission and consultation guidelines\|Admission and consultation guidelines (policy 312)]]
	**[[Harbor:Right level of care\|Right level of care]]
	**[[Harbor:Internal Medicine Admissions\|Internal Medicine Admission Template]]
	**[[Harbor:C-Team\|C-Team Admissions]]
	**[[Harbor:Who Goes to Family Medicine\|Who Goes to Family Medicine]]
	*[[Harbor:Post-admission management\|Post-admission management/Orders on Admitted Patients]]

	~~===[[Harbor:Direct Admission after Hours\|Direct Admission after Hours]]===~~

	~~===Insurance Problems===~~
	# ~~For issues with insurance, refer patients to the CA Dept of Managed Healthcare: https://www.dmhc.ca.gov/~~

	~~==Physicians==~~
	~~===[[Harbor:Forms\|Forms]]===~~

	~~===[[Harbor:PC Cheat Sheet\|PC Cheat Sheet]]===~~

	~~===[[Harbor:Phone numbers\|Phone numbers]]===~~
	~~===[[Harbor:Paging]]===~~

	~~===[[Harbor:ED attending on call plan\|ED attending on call plan]]===~~

	~~===[[Harbor:Trauma activations\|Trauma Activations]]===~~

	~~===[[Harbor:Code STEMI\|STEMI Activation]]===~~
	*[[Harbor:EKG STEMI Screening\|ECG STEMI screening]]

	~~===[[Harbor:Code stroke\|Code Stroke]]===~~

	~~===[[Harbor:Scheduled dialysis patients in ED\|Scheduled dialysis patients in ED]]===~~

	~~==Documentation==~~
	~~===[[Harbor:Attending documentation\|Attending Documentation]]===~~

	~~===[[Harbor:Resident documentation\|Resident documentation]]===~~


	~~===[[Harbor:Prescribing\|Prescribing]]===~~

	~~===[[Harbor:Codes\|Codes]]===~~

	~~===[[Harbor:Airway management team\|Airway management team]]===~~

	~~===[[Harbor: Macros and Autotext\|Macros and Autotext]]===~~

	~~==[[Harbor:RME & TRIAGE\|RME & TRIAGE]]==~~

	~~==LEGAL==~~
	~~[[Harbor:Legal]]~~

	~~==[[Harbor:Social work\|Social work]]==~~

	~~===[[Harbor:Whole person care\|Whole person care]]===~~

	~~==[[Harbor:Core Measures\|Core Measures]]==~~

	~~==[[Harbor:ED policy manual\|Harbor ED policy manual]]==~~

	~~==See Also==~~
	*[[Harbor: Main]]
	*[[Harbor:Code STEMI]]

	~~==References==~~
	~~<references/>~~

	~~[[Category:Admin~~]]

Rossdonaldson1: /* Boarding Patients Sent from Clinic */

2019-01-31T05:22:58Z

Boarding Patients Sent from Clinic

← Revisión anterior		Revisión del 05:22 31 ene 2019
Línea 61:		Línea 61:
	**[[Harbor:Who Goes to Family Medicine\|Who Goes to Family Medicine]]		**[[Harbor:Who Goes to Family Medicine\|Who Goes to Family Medicine]]
	*[[Harbor:Post-admission management\|Post-admission management/Orders on Admitted Patients]]		*[[Harbor:Post-admission management\|Post-admission management/Orders on Admitted Patients]]

	~~===Boarding Patients Sent from Clinic===~~
	Just a reminder to the seniors in the Emergency Department running the board: the correct procedure for patients admitted from clinic who do not need a monitored bed, especially when the clinic is closing, is for the clinic to contact the patient flow facilitator to assist in locating a bed in the hospital, and only contact the emergency department to board the patient if the flow facilitator cannot make other arrangements.

	Monitored bed patients can be sent from the clinic to the emergency department to board when we are out of monitored beds. If it does not sound like the patient needs a monitored bed, please talk to the ED attending.

	~~(Dir. OPS, February 03, 2015)~~

	===[[Harbor:Direct Admission after Hours\|Direct Admission after Hours]]===		===[[Harbor:Direct Admission after Hours\|Direct Admission after Hours]]===

Rossdonaldson1: /* ED Procedure Videos */

2019-01-31T05:22:05Z

ED Procedure Videos

← Revisión anterior		Revisión del 05:22 31 ene 2019
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	===[[Harbor:Scheduled dialysis patients in ED\|Scheduled dialysis patients in ED]]===		===[[Harbor:Scheduled dialysis patients in ED\|Scheduled dialysis patients in ED]]===

	~~===ED Procedure Videos===~~
	* LP
	* Para ...

	==Documentation==		==Documentation==

Rossdonaldson1: /* Physicians */

2019-01-31T05:21:45Z

Physicians

← Revisión anterior		Revisión del 05:21 31 ene 2019
Línea 91:		Línea 91:
	===[[Harbor:Code stroke\|Code Stroke]]===		===[[Harbor:Code stroke\|Code Stroke]]===

	===Scheduled ~~Dialysis Patients~~ in ED===		===[[Harbor:Scheduled dialysis patients in ED\|Scheduled dialysis patients in ED]]===
	~~#The router will place them on the pre-arrivals each AM (M/W/F)~~
	~~#HD times should be 5-9a and 930-130p~~
	#They will receive a MSE at triage – if they decline the MSE and only want their scheduled HD, please document that “the patient declined a MSE and no emergent medical condition exists at this time” in the MSE note and we are done from the ED perspective
	#If the patient appears unstable, please discuss with one of the AED attendings to determine if they need to be on an AED team or simply need dialysis with a call to the nephrologist for urgent evaluation.
	~~#Once the MSE is performed, they will be taken to one of our HD rooms – preferentially Gold 29, then RME 19, then Acute 15 (likely a max of 2 rooms at a time).~~
	~~#They will be cared for by the nephrologist (typically Dr. Anuja Shah) who will place the discharge orders (so these patients should NOT be placed on AED teams).~~
	#If for some reason Dr. Shah is unable to evaluate the patient prior to discharge, the FastTrack NP (not resident) will briefly evaluate the patient when ready for discharge - documenting vitals, heart, lung, and lower extremity exam, and page Dr. Shah to clear for dispo and subsequently print the discharge instructions (“HEMODIALYSIS” patient education).
	~~#The NP will forward the chart to Dr. Shah, not ED R4 or Attending.~~
	~~Chappell 12-1-17~~

	===ED Procedure Videos===		===ED Procedure Videos===

Rossdonaldson1: /* Physicians */

2019-01-31T05:20:55Z

Physicians

← Revisión anterior		Revisión del 05:20 31 ene 2019
Línea 84:		Línea 84:
	===[[Harbor:ED attending on call plan\|ED attending on call plan]]===		===[[Harbor:ED attending on call plan\|ED attending on call plan]]===

	===Trauma Activations===		===[[Harbor:Trauma activations\|Trauma Activations]]===
	In addition to the standard trauma activation criteria published on a badge card that everyone should carry and refer to, the Trauma Service can be activated in patients not meeting trauma criteria to help in several ways:
	~~#Getting CT scans READ quickly (Trauma will read them)~~
	~~#Getting lots of extra hands to do whatever needs to be done for the patient.~~
	~~#Getting surgical decisions made more quickly.~~

	~~You can even activate the trauma service if you have a non-trauma patient that needs emergent surgical intervention.~~

	~~All of these decisions are covered under "ED Judgment"~~

	~~(Dir OPS 7/15)~~


	===[[Harbor:Code STEMI\|STEMI Activation]]===		===[[Harbor:Code STEMI\|STEMI Activation]]===

Rossdonaldson1: /* LEGAL */

2019-01-31T05:18:57Z

LEGAL

@@ Línea 134: / Línea 134: @@
 ==LEGAL==
+[[Harbor:Legal]]
 ==[[Harbor:Social work|Social work]]==

Rossdonaldson1: /* Radiology */

2019-01-31T05:17:04Z

Radiology

@@ Línea 19: / Línea 19: @@
 *[[Harbor:Rules for Performing ED Ultrasounds|Formal & ED Ultrasounds]]
 *[[Harbor:STAT MRI|STAT MRI]]
-===Discrepancy E-mail===
+*[[Harbor:Example text for a discrepancy e-mail|Example text for a discrepancy e-mail]]
 ==EQUIPMENT==

Rossdonaldson1 at 05:10, 31 January 2019

2019-01-31T05:10:49Z

← Revisión anterior		Revisión del 05:10 31 ene 2019
Línea 13:		Línea 13:

	==[[Harbor:Labs\|Labs]]==		==[[Harbor:Labs\|Labs]]==

	~~===Specimen Collection by Providers===~~
	~~#Provider places order for specimen~~
	~~#Request clerk/nurse to print labels~~
	~~#Provider affix label to specimen~~
	~~#Leave specimen in room on cart~~
	~~#NO NEED TO INITIAL OR PUT PROVIDER ID ON LABEL~~
	~~#If no specimen labels printed~~
	~~##Affix generic patient label~~
	~~##RN prints and affixes specimen label~~
	~~#Provider notifies RN specimen ready to send~~
	~~##If RN unavailable notify Charge RN~~
	~~#RN scans specimen and patient wristband~~
	~~#RN sends to lab~~
	~~(Wu 1/2019)~~

	==Radiology==		==Radiology==

Rossdonaldson1: /* Surge Criteria and Plan */

2019-01-31T05:04:12Z

Surge Criteria and Plan

← Revisión anterior		Revisión del 05:04 31 ene 2019
Línea 5:		Línea 5:
	===Surge Criteria and Plan===		===Surge Criteria and Plan===
	*[[Harbor:Surge Plan/Disasters\|Harbor Surge Plan/Disasters]]		*[[Harbor:Surge Plan/Disasters\|Harbor Surge Plan/Disasters]]
	*[[Harbor:~~Disasters~~ plan\|Harbor disaster plan]]		*[[Harbor:Disaster plan\|Harbor disaster plan]]

	===Orchid Downtime===		===Orchid Downtime===

Rossdonaldson1 at 04:58, 31 January 2019

2019-01-31T04:58:44Z

@@ Línea 6: / Línea 6: @@
 *[[Harbor:Surge Plan/Disasters|Harbor Surge Plan/Disasters]]
 *[[Harbor:Disasters plan|Harbor disaster plan]]
 ===Orchid Downtime===

← Revisión anterior		Revisión del 05:24 31 ene 2019
Línea 1:		Línea 1:
	~~==Pre-hospital/Surge Plans==~~		#REDIRECT[[Harbor:Main]]
	~~===[[Harbor:Incoming transfers\|Incoming transfers]]===~~
	~~===Ambulance Triage===~~
	*[[Harbor:Screening EMS Patients\|Screening EMS Patients]]
	~~===Surge Criteria and Plan===~~
	*[[Harbor:Surge Plan/Disasters\|Harbor Surge Plan/Disasters]]
	*[[Harbor:Disaster plan\|Harbor disaster plan]]

	~~===Orchid Downtime===~~
	*[[Harbor:ORCHID Downtime\|ORCHID Downtime]]
	~~===ID: Flu, Hepatitis, Ebola===~~
	*[[Harbor:Infectious Disease Threats\|Infectious Disease Threats]]

	~~==[[Harbor:Labs\|Labs]]==~~

	~~==Radiology==~~
	*[[Harbor:ED Radiology Specs\|MRI Specs]]
	*[[Harbor:ED Radiology Specs\|CT Specs]]
	*[[Harbor:Rules for Performing ED Ultrasounds\|Formal & ED Ultrasounds]]
	*[[Harbor:STAT MRI\|STAT MRI]]
	*[[Harbor:Example text for a discrepancy e-mail\|Example text for a discrepancy e-mail]]

	~~==EQUIPMENT==~~
	*[[Harbor:Equipment\|Equipment (AED/RME)]]
	*[[Harbor:Equipment and supplies (peds)\|Equipment (peds)]]
	~~===Ordering DME===~~
	*[[Harbor:DME\|Durable Medical Equipment (DME)]]

	~~==IA/Exposures==~~
	~~===[[Harbor:Occupational exposure\|Occupational Exposure]]===~~
	*[[Harbor:Industrial Accident (IA)\|Industrial or On-the-Job Accidents (IA)]]
	~~===Sexual Assult/STI Exposure===~~
	*[[Harbor:Non-Occupational Exposure\|Sexual Assult/STI Exposure]]

	~~==Patient Disposition==~~
	~~===F/up Flowchart===~~
	* https://gallery.mailchimp.com/9d46ba488168336ff904bf5e2/files/f3e83cc1-58eb-404b-99c7-5c1a5542ddaf/ED_followup_flowchart_3_7_18.pdf ED follow up flow chart]
	~~===[[Harbor: ED Follow-Up Options\|ED Follow-Up Clinics]]===~~

	~~===[[Harbor:Discharge\|Law Enforcement Escort]]===~~
	*[[Harbor:Prescribing\|Prescribing]]

	~~===Other===~~
	*[[Harbor:Deceased patients\|Deceased patients]]
	*[[Harbor:Transferring a patient\|Transferring a patient]]
	**[[Harbor:Transferring to psych ER\|Transferring to psych ER]]

	~~==ADMISSIONS==~~
	~~===Admission Policy===~~
	*[[Harbor:Admitting a patient\|Admitting a patient]]

	~~=== OBS & CORE===~~
	*[[Harbor:Observation placement\|Observation placement]]
	*[[Harbor:CORE\|CORE placement]]

	~~===Admission Guidelines===~~
	*[[Harbor:Admission and consultation guidelines\|Admission and consultation guidelines (policy 312)]]
	**[[Harbor:Right level of care\|Right level of care]]
	**[[Harbor:Internal Medicine Admissions\|Internal Medicine Admission Template]]
	**[[Harbor:C-Team\|C-Team Admissions]]
	**[[Harbor:Who Goes to Family Medicine\|Who Goes to Family Medicine]]
	*[[Harbor:Post-admission management\|Post-admission management/Orders on Admitted Patients]]

	~~===[[Harbor:Direct Admission after Hours\|Direct Admission after Hours]]===~~

	~~===Insurance Problems===~~
	# ~~For issues with insurance, refer patients to the CA Dept of Managed Healthcare: https://www.dmhc.ca.gov/~~

	~~==Physicians==~~
	~~===[[Harbor:Forms\|Forms]]===~~

	~~===[[Harbor:PC Cheat Sheet\|PC Cheat Sheet]]===~~

	~~===[[Harbor:Phone numbers\|Phone numbers]]===~~
	~~===[[Harbor:Paging]]===~~

	~~===[[Harbor:ED attending on call plan\|ED attending on call plan]]===~~

	~~===[[Harbor:Trauma activations\|Trauma Activations]]===~~

	~~===[[Harbor:Code STEMI\|STEMI Activation]]===~~
	*[[Harbor:EKG STEMI Screening\|ECG STEMI screening]]

	~~===[[Harbor:Code stroke\|Code Stroke]]===~~

	~~===[[Harbor:Scheduled dialysis patients in ED\|Scheduled dialysis patients in ED]]===~~

	~~==Documentation==~~
	~~===[[Harbor:Attending documentation\|Attending Documentation]]===~~

	~~===[[Harbor:Resident documentation\|Resident documentation]]===~~


	~~===[[Harbor:Prescribing\|Prescribing]]===~~

	~~===[[Harbor:Codes\|Codes]]===~~

	~~===[[Harbor:Airway management team\|Airway management team]]===~~

	~~===[[Harbor: Macros and Autotext\|Macros and Autotext]]===~~

	~~==[[Harbor:RME & TRIAGE\|RME & TRIAGE]]==~~

	~~==LEGAL==~~
	~~[[Harbor:Legal]]~~

	~~==[[Harbor:Social work\|Social work]]==~~

	~~===[[Harbor:Whole person care\|Whole person care]]===~~

	~~==[[Harbor:Core Measures\|Core Measures]]==~~

	~~==[[Harbor:ED policy manual\|Harbor ED policy manual]]==~~

	~~==See Also==~~
	*[[Harbor: Main]]
	*[[Harbor:Code STEMI]]

	~~==References==~~
	~~<references/>~~

	~~[[Category:Admin~~]]