Harbor:Replantation Patients - Revision history

Bchap23: /* Transfer Protocol */

2025-09-24T07:22:17Z

Transfer Protocol

← Older revision		Revision as of 07:22, 24 September 2025
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	=== [https://lacounty.sharepoint.com/:b:/t/EDOperations-HUCLA-5-JenandKelsey/EQZqEWzpwb9MsHyxQrYssJYBrBGw6WhoXSMky23Cti6m2Q?e=kid0Z9 Replant Flow Diagram] ===		=== [https://lacounty.sharepoint.com/:b:/t/EDOperations-HUCLA-5-JenandKelsey/EQZqEWzpwb9MsHyxQrYssJYBrBGw6WhoXSMky23Cti6m2Q?e=kid0Z9 Replant Flow Diagram] ===
	==Transfer Protocol==		==Transfer Protocol==
	* Obtain a STAT ~~Orthopedic~~ Consult and page out as a TTA2 if not done already		* Obtain a STAT Hand Call Consult and page out as a TTA2 if not done already
	** ~~Orthopedic~~ consultant should come to the ED for emergent evaluation		** Hand Call consultant should come to the ED for emergent evaluation
	*** '''The ~~Orthopedic~~ resident must staff with their attending prior to recommending transfer'''		*** '''The Hand Call resident must staff with their attending prior to recommending transfer'''

	* If the patient is deemed a potential replantation candidate:		* If the patient is deemed a potential replantation candidate:
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	**** Location: ED room number		**** Location: ED room number
	** MAC will connect the '''ED attending with the LAG Hand Call ATTENDING''' via recorded line to discuss the replant candidate transfer		** MAC will connect the '''ED attending with the LAG Hand Call ATTENDING''' via recorded line to discuss the replant candidate transfer
	*** The ~~orthopedic~~ consultant (senior resident) should be immediately available to answer any technical questions from the LAG Replant Surgeon on the recorded MAC line; '''if there is any discrepancy, the HUMC ~~Ortho~~ ATTENDING must speak with the LAG Hand ATTENDING'''		*** The Hand Call consultant (senior resident) should be immediately available to answer any technical questions from the LAG Replant Surgeon on the recorded MAC line; '''if there is any discrepancy, the HUMC Hand Call ATTENDING must speak with the LAG Hand Call ATTENDING'''
	*** If the LAG Attending cannot be reached within '''15 minutes''', MAC will contact the LAG CMO/MOD and MAC Medical Supervisor to present the transfer request		*** If the LAG Attending cannot be reached within '''15 minutes''', MAC will contact the LAG CMO/MOD and MAC Medical Supervisor to present the transfer request
	*** If the transfer conversation is not initiated wihin 60 minutes, MAC will contact the DHS CMO		*** If the transfer conversation is not initiated wihin 60 minutes, MAC will contact the DHS CMO

Bchap23: /* Dealing with Disagreements Regarding Transfer */

2025-02-04T23:03:07Z

Dealing with Disagreements Regarding Transfer

← Older revision		Revision as of 23:03, 4 February 2025
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	* If there is disagreement between HUCLA ED/Trauma/Ortho Consultant and Hand LAC+USC Replantation service about proceeding with replantation then '''HUCLA Ortho Attending must talk to LAC+USC Replantation Attending on the recorded MAC line'''		* If there is disagreement between HUCLA ED/Trauma/Ortho Consultant and Hand LAC+USC Replantation service about proceeding with replantation then '''HUCLA Ortho Attending must talk to LAC+USC Replantation Attending on the recorded MAC line'''
	* If there continues to be disagreement - the patient WILL be accepted by LAC+USC for an in-person evaluation by the replantation service (per CMO's at LAC+USC and HUCLA) - please involve both Trauma Attending and Hand Attending [[https://wikem.org/wiki/DEM_Admin_on_Duty_(AOD)\|DEM Admin on Duty (AOD)]]		* If there continues to be disagreement - the patient WILL be accepted by LAC+USC for an in-person evaluation by the replantation service (per CMO's at LAC+USC and HUCLA) - please involve both Trauma Attending and Hand Attending [[https://wikem.org/wiki/DEM_Admin_on_Duty_(AOD)\|DEM Admin on Duty (AOD)]]
	** After in-person evaluation, this may result in operative intervention		** After in-person evaluation by the LAG re-plant surgeon, this may result in operative intervention
	** If the patient is deemed non-operative, the patient will either be discharged by LAG or returned via County Trans to HUMC (rare event)		** If the patient is deemed non-operative, the patient will either be discharged by LAG or returned via County Trans to HUMC (rare event)

Bchap23: /* Dealing with Disagreements Regarding Transfer */

2025-02-04T21:03:26Z

Dealing with Disagreements Regarding Transfer

← Older revision		Revision as of 21:03, 4 February 2025
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	* If there is disagreement between HUCLA ED/Trauma/Ortho Consultant and Hand LAC+USC Replantation service about proceeding with replantation then '''HUCLA Ortho Attending must talk to LAC+USC Replantation Attending on the recorded MAC line'''		* If there is disagreement between HUCLA ED/Trauma/Ortho Consultant and Hand LAC+USC Replantation service about proceeding with replantation then '''HUCLA Ortho Attending must talk to LAC+USC Replantation Attending on the recorded MAC line'''
	* If there continues to be disagreement - the patient WILL be accepted by LAC+USC for an in-person evaluation by the replantation service (per CMO's at LAC+USC and HUCLA) - please involve both Trauma Attending and Hand Attending [[https://wikem.org/wiki/DEM_Admin_on_Duty_(AOD)\|DEM Admin on Duty (AOD)]]		* If there continues to be disagreement - the patient WILL be accepted by LAC+USC for an in-person evaluation by the replantation service (per CMO's at LAC+USC and HUCLA) - please involve both Trauma Attending and Hand Attending [[https://wikem.org/wiki/DEM_Admin_on_Duty_(AOD)\|DEM Admin on Duty (AOD)]]
			** After in-person evaluation, this may result in operative intervention
			** If the patient is deemed non-operative, the patient will either be discharged by LAG or returned via County Trans to HUMC (rare event)

	==Repatriation==		==Repatriation==

Kwilhelm: /* Dealing with Disagreements Regarding Transfer */

2024-07-02T21:02:51Z

Dealing with Disagreements Regarding Transfer

← Older revision		Revision as of 21:02, 2 July 2024
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	==Dealing with Disagreements Regarding Transfer==		==Dealing with Disagreements Regarding Transfer==
	* If there is disagreement between HUCLA ED/Trauma/~~Hand Call~~ Consultant and Hand LAC+USC Replantation service about proceeding with replantation then '''HUCLA ~~Hand Call~~ Attending must talk to LAC+USC Replantation Attending on the recorded MAC line'''		* If there is disagreement between HUCLA ED/Trauma/Ortho Consultant and Hand LAC+USC Replantation service about proceeding with replantation then '''HUCLA Ortho Attending must talk to LAC+USC Replantation Attending on the recorded MAC line'''
	* If there continues to be disagreement - the patient WILL be accepted by LAC+USC for an in-person evaluation by the replantation service (per CMO's at LAC+USC and HUCLA) - please involve both Trauma Attending and Hand Attending [[https://wikem.org/wiki/DEM_Admin_on_Duty_(AOD)\|DEM Admin on Duty (AOD)]]		* If there continues to be disagreement - the patient WILL be accepted by LAC+USC for an in-person evaluation by the replantation service (per CMO's at LAC+USC and HUCLA) - please involve both Trauma Attending and Hand Attending [[https://wikem.org/wiki/DEM_Admin_on_Duty_(AOD)\|DEM Admin on Duty (AOD)]]

Kwilhelm: /* Transfer Protocol */

2024-07-02T21:02:17Z

Transfer Protocol

← Older revision		Revision as of 21:02, 2 July 2024
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	''For immediate clinical management see "[[Replantation]]"''		''For immediate clinical management see "[[Replantation]]"''
			=== [https://lacounty.sharepoint.com/:b:/t/EDOperations-HUCLA-5-JenandKelsey/EQZqEWzpwb9MsHyxQrYssJYBrBGw6WhoXSMky23Cti6m2Q?e=kid0Z9 Replant Flow Diagram] ===
	==Transfer Protocol==		==Transfer Protocol==
	~~=== [https://lacounty.sharepoint.com/:b:/t/EDOperations-HUCLA-5-JenandKelsey/EQZqEWzpwb9MsHyxQrYssJYBrBGw6WhoXSMky23Cti6m2Q?e=kid0Z9 Replant Flow Diagram] ===~~
	* Obtain a STAT Orthopedic Consult and page out as a TTA2 if not done already		* Obtain a STAT Orthopedic Consult and page out as a TTA2 if not done already
	** Orthopedic consultant should come to the ED for emergent evaluation		** Orthopedic consultant should come to the ED for emergent evaluation

Kwilhelm: /* Transfer Protocol */

2024-07-02T20:55:15Z

Transfer Protocol

← Older revision		Revision as of 20:55, 2 July 2024
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	''For immediate clinical management see "[[Replantation]]"''		''For immediate clinical management see "[[Replantation]]"''
	==Transfer Protocol==		==Transfer Protocol==
	* Obtain a STAT ~~Hand Call~~ Consult and page out as a TTA2 if not done already		=== [https://lacounty.sharepoint.com/:b:/t/EDOperations-HUCLA-5-JenandKelsey/EQZqEWzpwb9MsHyxQrYssJYBrBGw6WhoXSMky23Cti6m2Q?e=kid0Z9 Replant Flow Diagram] ===
	** ~~Hand call~~ consultant should come to the ED for emergent evaluation		* Obtain a STAT Orthopedic Consult and page out as a TTA2 if not done already
	*** Hand call rotates between Ortho & Plastics; check the doc box for who is on for the day		** Orthopedic consultant should come to the ED for emergent evaluation
	*** For Plastics, ensure that the senior resident has evaluated the patient		*** '''The Orthopedic resident must staff with their attending prior to recommending transfer'''
	*** '''The ~~hand call consulting~~ resident must staff with their attending prior to recommending transfer'''

	* If the patient is deemed a potential replantation candidate:		* If the patient is deemed a potential replantation candidate:
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	**** Location: ED room number		**** Location: ED room number
	** MAC will connect the '''ED attending with the LAG Hand Call ATTENDING''' via recorded line to discuss the replant candidate transfer		** MAC will connect the '''ED attending with the LAG Hand Call ATTENDING''' via recorded line to discuss the replant candidate transfer
	*** The ~~hand~~ consultant (senior resident) should be immediately available to answer any technical questions from the LAG Replant Surgeon on the recorded MAC line; '''if there is any discrepancy, the HUMC ~~Hand~~ ATTENDING must speak with the LAG Hand ATTENDING'''		*** The orthopedic consultant (senior resident) should be immediately available to answer any technical questions from the LAG Replant Surgeon on the recorded MAC line; '''if there is any discrepancy, the HUMC Ortho ATTENDING must speak with the LAG Hand ATTENDING'''
	*** If the LAG Attending cannot be reached within '''15 minutes''', MAC will contact the LAG CMO/MOD and MAC Medical Supervisor to present the transfer request		*** If the LAG Attending cannot be reached within '''15 minutes''', MAC will contact the LAG CMO/MOD and MAC Medical Supervisor to present the transfer request
	*** If the transfer conversation is not initiated wihin 60 minutes, MAC will contact the DHS CMO		*** If the transfer conversation is not initiated wihin 60 minutes, MAC will contact the DHS CMO
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	**TRANSFERS FOR POTENTIAL REPLANTATION WILL PROCEED REGARDLESS OF WHETHER LAG HAS AVAILABLE BEDS (even if closed to transfers per USC CMO Dr. Spellberg)		**TRANSFERS FOR POTENTIAL REPLANTATION WILL PROCEED REGARDLESS OF WHETHER LAG HAS AVAILABLE BEDS (even if closed to transfers per USC CMO Dr. Spellberg)

	Gausche-Hill, Mahajan, Chappell 6/30/23		Gausche-Hill, Mahajan, Chappell, Wilhelm 7/1/24

	==Dealing with Disagreements Regarding Transfer==		==Dealing with Disagreements Regarding Transfer==

Bchap23: /* Transfer Protocol */

2023-07-02T00:01:52Z

Transfer Protocol

← Older revision		Revision as of 00:01, 2 July 2023
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	** '''If MAC is unable to provide transport for Higher Level of Care Urgent/Emergent transfer within a reasonable amount of time (less than 2 hours) this issue should be escalated to the MAC Medical Officer of the Day (MOD), DEM Admin on Duty (AOD), and the Attending Trauma Surgeon'''		** '''If MAC is unable to provide transport for Higher Level of Care Urgent/Emergent transfer within a reasonable amount of time (less than 2 hours) this issue should be escalated to the MAC Medical Officer of the Day (MOD), DEM Admin on Duty (AOD), and the Attending Trauma Surgeon'''
	**TRANSFERS FOR POTENTIAL REPLANTATION WILL PROCEED REGARDLESS OF WHETHER LAG HAS AVAILABLE BEDS (even if closed to transfers per USC CMO Dr. Spellberg)		**TRANSFERS FOR POTENTIAL REPLANTATION WILL PROCEED REGARDLESS OF WHETHER LAG HAS AVAILABLE BEDS (even if closed to transfers per USC CMO Dr. Spellberg)

			Gausche-Hill, Mahajan, Chappell 6/30/23

	==Dealing with Disagreements Regarding Transfer==		==Dealing with Disagreements Regarding Transfer==

Bchap23: /* Transfer Protocol */

2023-07-01T17:28:16Z

Transfer Protocol

← Older revision		Revision as of 17:28, 1 July 2023
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	** Name of transferring (sending) attending physician and the name of the DEM AOD*		** Name of transferring (sending) attending physician and the name of the DEM AOD*
	**** Location: ED room number		**** Location: ED room number
	** MAC will connect the ED attending with the LAG Hand Call ATTENDING via recorded line to discuss the replant candidate transfer		** MAC will connect the '''ED attending with the LAG Hand Call ATTENDING''' via recorded line to discuss the replant candidate transfer
	*** The hand consultant (senior resident) should be immediately available to answer any technical questions from the LAG Replant Surgeon on the recorded MAC line; '''if there is any discrepancy, the HUMC Hand ATTENDING must speak with the LAG Hand ATTENDING'''		*** The hand consultant (senior resident) should be immediately available to answer any technical questions from the LAG Replant Surgeon on the recorded MAC line; '''if there is any discrepancy, the HUMC Hand ATTENDING must speak with the LAG Hand ATTENDING'''
	*** If the LAG Attending cannot be reached within '''15 minutes''', MAC will contact the LAG CMO/MOD and MAC Medical Supervisor to present the transfer request		*** If the LAG Attending cannot be reached within '''15 minutes''', MAC will contact the LAG CMO/MOD and MAC Medical Supervisor to present the transfer request
	*** If the transfer is not initiated wihin 60 minutes, MAC will contact the DHS CMO		*** If the transfer conversation is not initiated wihin 60 minutes, MAC will contact the DHS CMO
	** Once the patient is accepted for transfer, ED provider coordinates further transfer logistics via MAC		** Once the patient is accepted for transfer, ED provider coordinates further transfer logistics via MAC
	*** '''Ask MAC for ETA of transport'''		*** '''Ask MAC for ETA of transport'''

Bchap23: /* Transfer Protocol */

2023-07-01T17:25:16Z

Transfer Protocol

← Older revision		Revision as of 17:25, 1 July 2023
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	* If the patient is deemed a potential replantation candidate:		* If the patient is deemed a potential replantation candidate:
	** '''The ED ATTENDING should call the MAC at 866-940-4401 and state:		** '''The ED ATTENDING should call the MAC''' at 866-940-4401 and state:
	*** "We are requesting an emergent/urgent transfer from HUMC ED to LAG ED for replant evaluation; I need you to arrange the transfer" '''		*** '''"We are requesting an emergent/urgent transfer from HUMC ED to LAG ED for replant evaluation; I need you to arrange the transfer" '''
	*** All Emergent/Urgent requests should get transfer approval/dispositioned within 60 minutes. [https://secure2.compliancebridge.com/lacdhs/DHSpublic/index.php?fuseaction=header.download&policyID=4374&descriptor=header1&doc=373.3.pdf DHS Policy 373.3 MAC Transfers]		*** All Emergent/Urgent requests should get transfer approval/dispositioned within 60 minutes. [https://secure2.compliancebridge.com/lacdhs/DHSpublic/index.php?fuseaction=header.download&policyID=4374&descriptor=header1&doc=373.3.pdf DHS Policy 373.3 MAC Transfers]
	*** MAC will ask for below info (at a minimum)		*** MAC will ask for below info (at a minimum)

Bchap23: /* Transfer Protocol */

2023-07-01T17:24:48Z

Transfer Protocol

← Older revision		Revision as of 17:24, 1 July 2023
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	* If the patient is deemed a potential replantation candidate:		* If the patient is deemed a potential replantation candidate:
	** '''The ED ATTENDING should call the MAC at 866-940-4401 and state: "We are requesting an emergent/urgent transfer from HUMC ED to ~~LAC+USC~~ ED for replant evaluation; I need you to arrange the transfer" '''		** '''The ED ATTENDING should call the MAC at 866-940-4401 and state:
			*** "We are requesting an emergent/urgent transfer from HUMC ED to LAG ED for replant evaluation; I need you to arrange the transfer" '''
	*** All Emergent/Urgent requests should get transfer approval/dispositioned within 60 minutes. [https://secure2.compliancebridge.com/lacdhs/DHSpublic/index.php?fuseaction=header.download&policyID=4374&descriptor=header1&doc=373.3.pdf DHS Policy 373.3 MAC Transfers]		*** All Emergent/Urgent requests should get transfer approval/dispositioned within 60 minutes. [https://secure2.compliancebridge.com/lacdhs/DHSpublic/index.php?fuseaction=header.download&policyID=4374&descriptor=header1&doc=373.3.pdf DHS Policy 373.3 MAC Transfers]
	*** MAC will ask for below info (at a minimum)		*** MAC will ask for below info (at a minimum)