Harbor:RME & TRIAGE - Revision history

Bchap23: /* Quick Guide */

2025-06-06T23:16:15Z

Quick Guide

← Older revision		Revision as of 23:16, 6 June 2025
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	*** Limit POC testing unless it will change your immediate management, especially if you are ordering the formal (no Hemaque if getting CBC)		*** Limit POC testing unless it will change your immediate management, especially if you are ordering the formal (no Hemaque if getting CBC)
	*** If drawing blood, get the serum HCG instead of urine (takes 5 min to to the quality check and run it)		*** If drawing blood, get the serum HCG instead of urine (takes 5 min to to the quality check and run it)
	*** For low acuity patients, place on orange FT team and ~~write~~ "ok UCC" ~~or "no UCC" in the RN comments column~~		*** For low acuity patients, place on orange FT team and mark event "ok for UCC"

	** NP		** NP

	** R3/4		** R3/4

Bchap23: /* Quick Guide */

2025-06-06T23:13:51Z

Quick Guide

← Older revision		Revision as of 23:13, 6 June 2025
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	* FastTrack		* FastTrack
	** General		** General
	*** RME 6-9 should have an assigned RN/LVN; if unclear who this is or none assigned, ask RME charge (~~23930~~), then OCN (~~23902~~), then Dr. Chappell (text/call cell)		*** RME 9-12, XH 1-8 should have an assigned RN/LVN; if unclear who this is or none assigned, ask RME charge (x66950), then OCN (x66930), then Dr. Chappell (text/call cell)
	*** RME 10, 11, & 12 are available for consultants, quick DC that does not require nursing, etc		*** Depending on RN staffing and PED volumes, may be able to use PED 7-10 (huddle with OCN, RME charge, and PED charge)
	*** Depending on RN staffing and PED volumes, may be able to use PED 8-11 (huddle with OCN, RME charge, and PED charge)
	*** Keep the rails up on the beds and have patients sit in the chairs in the rooms unless YOU need them in a bed (US, procedure, abd exam, pelvic, etc)		*** Keep the rails up on the beds and have patients sit in the chairs in the rooms unless YOU need them in a bed (US, procedure, abd exam, pelvic, etc)
	*** If you are seeing a patient in the chairs and need to do an exam, can use open room in RME or PED or set up a curtain in Peds X-ray WR		*** If you are seeing a patient in the chairs and need to do an exam, can use open room in RME or PED or set up a curtain in Peds X-ray WR

	** R4		** R4
	*** Team huddle at 3p and 7p - FT R2, NPs, RME charge, and FT RN/LVN		*** Team huddle at 3p and 7:30p - FT R2, NPs, RME charge, and FT RN/LVN
	** R2		** R2

	** NP		** NP
	*** Team huddle at ~~9a and noon~~ - FT NPs, RME charge, and FT RN/LVN		*** Team huddle at 7:30a, 3p, 7:30p - FT NPs, RME charge, and FT RN/LVN
	*** Perform 5-S (check carts; have USA assist)		*** Perform 5-S (check carts; have USA assist)
	*** If not immediate DC, work patients in parallel - complete chart to MDM then see next patient; should be able to easily juggle 4 at a time		*** If not immediate DC, work patients in parallel - complete chart to MDM then see next patient; should be able to easily juggle 4 at a time
			*** FT patient signouts go to Surple senior at 23:45

	===RME Patient Flow===		===RME Patient Flow===

Bchap23: /* Transfer of Low Acuity Patients from ED to UCC */

2022-10-07T20:52:55Z

Transfer of Low Acuity Patients from ED to UCC

← Older revision		Revision as of 20:52, 7 October 2022
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	** RME Process:		** RME Process:
	*** If the patient is appropriate for UCC (ESI 4/5 and does not have exclusions), the triage then RME provider will right-click '''EVENT column''' and click '''OK For UCC''' creating a stick man logo		*** If the patient is appropriate for UCC (ESI 4/5 and does not have exclusions), the triage then RME provider will right-click '''EVENT column''' and click '''OK For UCC''' creating a stick man logo
	*** The PRR in triage will make an UCC appointment if the patient is DHS eligible, or cancel the ~~even~~ if OOP		*** The PRR in triage will make an UCC appointment if the patient is DHS eligible, or cancel the event (removing the stick man) if OOP
	**** (Urgent Care Clinic New, HAR ED, move, suggest; can click on the calendar)		**** (Urgent Care Clinic New, HAR ED, move, suggest; can click on the calendar)
	***** 8a-4p=36 appts, 2p-9p=36 appts; Sat=21 appts		***** 8a-4p=36 appts, 2p-9p=36 appts; Sat=21 appts

Bchap23 at 17:32, 7 October 2022

2022-10-07T17:32:54Z

@@ Line 359: / Line 359: @@
 ====Urgent Care====
 =====Transfer of Low Acuity Patients from ED to UCC=====
-*UCC Charge RN:  x64110, 64111;    RME Charge x23930
+*UCC Charge RN:  x64110, 64111;    RME Charge x66950
 * Starting 2/16/21
 ** UCC Hours:

Bchap23: /* Transfer of Low Acuity Patients from ED to UCC */

2022-07-26T16:36:35Z

Transfer of Low Acuity Patients from ED to UCC

← Older revision		Revision as of 16:36, 26 July 2022
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	** UCC Hours:		** UCC Hours:
	*** Mon, Wed, Thurs, Fri 8a - 10p (transfer until 8p)		*** Mon, Wed, Thurs, Fri 8a - 10p (transfer until 8p)
	*** Tuesday 8a-10p (transfer 10a - 8p due to AM grand rounds)		*** Tuesday 8a-10p ('''transfer 10a''' - 8p due to AM grand rounds)
	*** Saturday 9a - 5p (transfer until 3p)		*** Saturday 9a - 5p (transfer until 3p)
	** Only '''DHS eligible ESI 4&5 patients''' will be transferred to UCC		** Only '''DHS eligible ESI 4&5 patients''' will be transferred to UCC ('''OOP ok during SURGE with approval by Dr. Gutierrez; Dr. Chappell will notify Dr. Hsieh and registration supervisor when this occurs''')
	*** There will be no restrictions on the types of ESI 4&5 patients		*** There will be no restrictions on the types of ESI 4&5 patients
	*** UCC can see pink patients when open rooms are available, but the ED will try to prioritize their discharge as space allows.		*** UCC can see pink patients when open rooms are available, but the ED will try to prioritize their discharge as space allows.
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	## The ability to do simple laceration repair is provider dependent, so please call prior to transferring such patients		## The ability to do simple laceration repair is provider dependent, so please call prior to transferring such patients
	# Despite best efforts to properly screen the patients, if it is later determined that a patient is OOP, they will still be seen in UCC and not returned to the ED simply for financial concerns in the spirit of patient-centered care.		# Despite best efforts to properly screen the patients, if it is later determined that a patient is OOP, they will still be seen in UCC and not returned to the ED simply for financial concerns in the spirit of patient-centered care.


	=====UCC Appropriate and Inappropriate List=====		=====UCC Appropriate and Inappropriate List=====

Bchap23: /* Quick Guide */

2021-07-19T21:12:22Z

Quick Guide

← Older revision		Revision as of 21:12, 19 July 2021
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	*** Depending on RN staffing and PED volumes, may be able to use PED 8-11 (huddle with OCN, RME charge, and PED charge)		*** Depending on RN staffing and PED volumes, may be able to use PED 8-11 (huddle with OCN, RME charge, and PED charge)
	*** Keep the rails up on the beds and have patients sit in the chairs in the rooms unless YOU need them in a bed (US, procedure, abd exam, pelvic, etc)		*** Keep the rails up on the beds and have patients sit in the chairs in the rooms unless YOU need them in a bed (US, procedure, abd exam, pelvic, etc)
			*** If you are seeing a patient in the chairs and need to do an exam, can use open room in RME or PED or set up a curtain in Peds X-ray WR

	** R4		** R4

Bchap23: /* 7-15-21 DRAFT Updates */

2021-07-15T03:52:33Z

7-15-21 DRAFT Updates

← Older revision		Revision as of 03:52, 15 July 2021
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	**** If we have an extra LVN, can shift the assignment to RME 7-10 for FT NP and add RME 5,6,11,12 for the MidTrack Resident team		**** If we have an extra LVN, can shift the assignment to RME 7-10 for FT NP and add RME 5,6,11,12 for the MidTrack Resident team
	**** Going back to the pre-COVID RME huddles at 9a (FT NP), noon (FT NP#2), 3p (R4/2), and 7p (night RNs) – FT NP, residents, RME charge, and FT/MidTrack Nurses		**** Going back to the pre-COVID RME huddles at 9a (FT NP), noon (FT NP#2), 3p (R4/2), and 7p (night RNs) – FT NP, residents, RME charge, and FT/MidTrack Nurses
	*** If we have a huge boarding volume (20+), and all our rooms are staffed, then we can consider surging into the X-unit for FastTrack (ESI 4/5) patients while using the other RME rooms for acute patient care		*** If we have a huge boarding volume (20+), and all our rooms are staffed, then we can consider surging into the X-unit for use by the FastTrack team (ESI 4/5) patients while using the other RME rooms for acute patient care
	**** Ideally, we would staff the hall as well, but if only placing ESI 4-5 in hall, we might be able to get away with utilizing tasking on the rare occasion additional workup is needed		**** Ideally, we would staff the hall as well, but if only placing ESI 4-5 in hall, we might be able to get away with utilizing tasking on the rare occasion additional workup is needed
	**** As the FT NP and the MidTrack R4/2 teams are done at midnight, no new hall patients after 23:00, and need to close down the hall by midnight (unless the teams have extra capacity due to boarding and the purple/green attendings are requesting to use the space; but preferentially should use peds rooms as their volumes are typically non-existent after ~2am).		**** As the FT NP and the MidTrack R4/2 teams are done at midnight, no new hall patients after 23:00, and need to close down the hall by midnight (unless the teams have extra capacity due to boarding and the purple/green attendings are requesting to use the space; but preferentially should use peds rooms as their volumes are typically non-existent after ~2am).

Bchap23: /* RME Patient Flow */

2021-07-14T22:21:29Z

RME Patient Flow

← Older revision		Revision as of 22:21, 14 July 2021
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			===7-15-21 DRAFT Updates===
			* Attendings and residents do thin-slicing when new patients are put on the teams – similar to brief interaction in triage: “Hi, I’m Dr. Chappell. I’m going to be taking care of your tonight. It’s really busy, but I wanted to get your workup started (or I see from the triage note you are here for ___). Your labs show some liver abnormalities. Let’s get you some nausea and pain medication, and I’m going to order an ultrasound. I’ll be back with you in a bit to talk some more about your history and see how you are feeling.” 3 minutes to let them know you are their doctor and stall for the next hour while you are catching up (and things are happening).
			* Adding 5th attending to Thursday, but starting at 11a based on the arrival volumes
			* Utilize RME as a flex unit based on patient arrival times (peak arrivals ~10a-2p, then steady until ~9p)
			** Nursing/bed assignments
			*** LVN assigned to R6-9 from 11a – 11p (staffed by NP’s 9a – MN)
			**** This area should be for all ESI 4/5 that do not go to UCC unless specifically stated on RN comments “AED team”
			**** The NPs can independently dispo all ESI 4&5 patients
			*** As we generally only have 1 RN assigned to RME 13-20 at 7a or 11a:
			**** RN in RME 17-20 from 7 or 11a with patients assigned equally to purple/green
			***** ESI 3 not assigned to FT team (or longest LOS)
			*** When the MidTrack resident team comes at 15:00:
			**** Start placing ESI 3 patients from the FT list in RME 13-16 M-F at 14:30 then staff with RN or LVN at 15:00
			**** If we have an extra LVN, can shift the assignment to RME 7-10 for FT NP and add RME 5,6,11,12 for the MidTrack Resident team
			**** Going back to the pre-COVID RME huddles at 9a (FT NP), noon (FT NP#2), 3p (R4/2), and 7p (night RNs) – FT NP, residents, RME charge, and FT/MidTrack Nurses
			*** If we have a huge boarding volume (20+), and all our rooms are staffed, then we can consider surging into the X-unit for FastTrack (ESI 4/5) patients while using the other RME rooms for acute patient care
			**** Ideally, we would staff the hall as well, but if only placing ESI 4-5 in hall, we might be able to get away with utilizing tasking on the rare occasion additional workup is needed
			**** As the FT NP and the MidTrack R4/2 teams are done at midnight, no new hall patients after 23:00, and need to close down the hall by midnight (unless the teams have extra capacity due to boarding and the purple/green attendings are requesting to use the space; but preferentially should use peds rooms as their volumes are typically non-existent after ~2am).
			*** Triage NP @ night – should stay in triage and can use the empty triage rooms for discharging low-acuity patients
			**** They are single coverage from MN to 7a, so with average arrivals of 3-4 per hour, I would expect 4-6 discharges from the triage NP per shift

	===AED FT in PED===		===AED FT in PED===

Bchap23: /* Quick Guide */

2021-07-13T23:03:01Z

Quick Guide

← Older revision		Revision as of 23:03, 13 July 2021
Line 40:		Line 40:

	** R4		** R4
			*** Team huddle at 3p and 7p - FT R2, NPs, RME charge, and FT RN/LVN
	** R2		** R2

	** NP		** NP
			*** Team huddle at 9a and noon - FT NPs, RME charge, and FT RN/LVN
	*** Perform 5-S (check carts; have USA assist)		*** Perform 5-S (check carts; have USA assist)
	*** If not immediate DC, work patients in parallel - complete chart to MDM then see next patient; should be able to easily juggle 4 at a time		*** If not immediate DC, work patients in parallel - complete chart to MDM then see next patient; should be able to easily juggle 4 at a time


	===RME Patient Flow===		===RME Patient Flow===

Bchap23: /* UCC Appropriate and Inappropriate List */

2021-07-13T18:59:24Z

UCC Appropriate and Inappropriate List

@@ Line 378: / Line 378: @@
 * UCC Parameters
 ** '''ALL DHS ESI 4 & 5 with the follow exceptions:'''
 *** Chest pain (with concern for cardiac etiology or age>40)