Harbor:Scheduled dialysis patients in ED - Revision history

Bchap23 at 07:42, 14 February 2024

2024-02-14T07:42:42Z

← Older revision		Revision as of 07:42, 14 February 2024
Line 4:		Line 4:
	* 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 (HTN will resolve with HD).		* 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 (HTN will resolve with HD).
	* ‘’’Covid test must be negative every 7 days’’’ per Dr Shah 8/24/22		* ‘’’Covid test must be negative every 7 days’’’ per Dr Shah 8/24/22
	* '''If symptomatic/COVID +ve OR Hep B +ve, HD will occur in ED - ~~G29~~>~~R19~~>~~A15~~>Tra1'''		* '''If symptomatic/COVID +ve OR Hep B +ve, HD will occur in ED - A25>A15>R7>Tra1'''
	** '''Hep B Surface Antigen must be negative within the past 30d; must repeat every 30 days'''		** '''Hep B Surface Antigen must be negative within the past 30d; must repeat every 30 days'''
	** '''COVID must be tested every 7 days''' (should be done during HD session on day 5)		** '''COVID must be tested every 7 days''' (should be done during HD session on day 5)

Bchap23 at 20:41, 29 November 2022

2022-11-29T20:41:28Z

← Older revision		Revision as of 20:41, 29 November 2022
Line 1:		Line 1:
	* The dialysis clerk will provide a ~~lit~~ of patient for the following day; the OCN will place them on the pre-arrival list each AM (M/W/F)		* The dialysis clerk will provide a list of patient for the following day; the OCN will place them on the pre-arrival list each AM (M/W/F)
	* HD times should be 5-9a and 930-130p		* HD times should be 5-9a and 930-130p
	* '''Patients should 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 is here for dialysis; the patient is hemodynamically stable and no EMC (emergent medical condition) exists at this time” in the MSE note and we are done from the ED perspective'''		* '''Patients should 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 is here for dialysis; the patient is hemodynamically stable and no EMC (emergent medical condition) exists at this time” in the MSE note and we are done from the ED perspective'''

Bchap23 at 15:31, 21 October 2022

2022-10-21T15:31:57Z

← Older revision		Revision as of 15:31, 21 October 2022
Line 6:		Line 6:
	* '''If symptomatic/COVID +ve OR Hep B +ve, HD will occur in ED - G29>R19>A15>Tra1'''		* '''If symptomatic/COVID +ve OR Hep B +ve, HD will occur in ED - G29>R19>A15>Tra1'''
	** '''Hep B Surface Antigen must be negative within the past 30d; must repeat every 30 days'''		** '''Hep B Surface Antigen must be negative within the past 30d; must repeat every 30 days'''
			** '''COVID must be tested every 7 days''' (should be done during HD session on day 5)
	** Patients getting dialyzed in the AED will be placed on teams; '''the team ONLY places DC order''' (no note necessary)		** Patients getting dialyzed in the AED will be placed on teams; '''the team ONLY places DC order''' (no note necessary)
	* For all other SCHEDULED HD patients, the RME USA will take the patient to the Transitional Dialysis Unit (5 West Room 10)		* For all other SCHEDULED HD patients, the RME USA will take the patient to the Transitional Dialysis Unit (5 West Room 10)

Bchap23 at 17:24, 25 August 2022

2022-08-25T17:24:26Z

← Older revision		Revision as of 17:24, 25 August 2022
Line 3:		Line 3:
	* '''Patients should 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 is here for dialysis; the patient is hemodynamically stable and no EMC (emergent medical condition) exists at this time” in the MSE note and we are done from the ED perspective'''		* '''Patients should 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 is here for dialysis; the patient is hemodynamically stable and no EMC (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 (HTN will resolve with HD).		* 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 (HTN will resolve with HD).
			* ‘’’Covid test must be negative every 7 days’’’ per Dr Shah 8/24/22
	* '''If symptomatic/COVID +ve OR Hep B +ve, HD will occur in ED - G29>R19>A15>Tra1'''		* '''If symptomatic/COVID +ve OR Hep B +ve, HD will occur in ED - G29>R19>A15>Tra1'''
	** '''Hep B Surface Antigen must be negative within the past 30d; must repeat every 30 days'''		** '''Hep B Surface Antigen must be negative within the past 30d; must repeat every 30 days'''

Bchap23 at 21:03, 1 March 2022

2022-03-01T21:03:53Z

@@ Line 1: / Line 1: @@
-#The router/OCN will place them on the pre-arrival list each AM (M/W/F)
+* The dialysis clerk will provide a lit of patient for the following day; the OCN will place them on the pre-arrival list each AM (M/W/F)
-#HD times should be 5-9a and 930-130p
+* 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'''
+* '''Patients should 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 is here for dialysis; the patient is hemodynamically stable and no EMC (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.
+* 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 (HTN will resolve with HD).
-#'''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).
+* '''If symptomatic/COVID +ve  OR Hep B +ve, HD will occur in ED - G29>R19>A15>Tra1'''
-#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).
+** '''Hep B Surface Antigen must be negative within the past 30d; must repeat every 30 days'''
-#'''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).'''
+** Patients getting dialyzed in the AED will be placed on teams; '''the team ONLY places DC order''' (no note necessary)
-#'''The NP will forward the chart to Dr. Shah, not ED R4 or Attending.'''
+* For all other SCHEDULED HD patients, the RME USA will take the patient to the Transitional Dialysis Unit (5 West Room 10)
 Dialysis patients with COVID Symptoms
 * Patients with assigned dialysis centers exhibiting symptoms or with a new COVID diagnosis
 ** '''Contact their dialysis center immediately to see if they can be placed in the COVID HD cohort'''
 *** If they cannot cohort:
 **** Consult nephrology to begin contingency planning
-***** During daytime hours, SW may be able to assist (there is one HD social worker)
+***** During daytime hours, SW may be able to assist (there is one Dialysis social worker)
 **** If patient just had HD, can send outpt COVID test
 **** If Pt requires HD in <24 hours, patient may need ED dialysis
@@ Line 23: / Line 42: @@
 **** Drs. Chappell & Shah (Nephrology) 7/2020
 ----------------------------------------------------------------------------------------------------------------------------------

Bchap23 at 02:17, 3 April 2021

2021-04-03T02:17:11Z

← Older revision		Revision as of 02:17, 3 April 2021
Line 1:		Line 1:
			#The router/OCN will place them on the pre-arrival list 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.'''



	Dialysis patients with COVID Symptoms		Dialysis patients with COVID Symptoms

	* Patients with assigned dialysis centers exhibiting symptoms or with a new COVID diagnosis		* Patients with assigned dialysis centers exhibiting symptoms or with a new COVID diagnosis
	** Contact their dialysis center immediately to see if they can be placed in the COVID HD cohort		** '''Contact their dialysis center immediately to see if they can be placed in the COVID HD cohort'''
	*** If they cannot cohort:		*** If they cannot cohort:
	**** Consult nephrology to begin contingency planning		**** Consult nephrology to begin contingency planning
	***** During daytime hours, SW may be able to assist (there is one HD social worker)		***** During daytime hours, SW may be able to assist (there is one HD social worker)
	**** If patient just had HD, can send outpt test ~~to MLK or Keck with ~24 hour TAT~~		**** If patient just had HD, can send outpt COVID test
	**** If Pt requires HD in <24 hours, patient may need ED dialysis		**** If Pt requires HD in <24 hours, patient may need ED dialysis
	**** If nephrology feels admission is warranted for HD, then '''rapid COVID test may be ordered''' (Dr. Mahajan 6/2020)
	***** If rapid test is negative, they can be discharged (and go back to their dialysis unit)		***** If rapid test is negative, they can be discharged (and go back to their dialysis unit)
	***** If positive, ~~will be needed for~~ admission		***** If positive, discuss admission with nephrology if unable to go back to their HD center (requires admission q30 days to enter the COVID transitional dialysis pathway)
	**** Drs. Chappell & Shah (Nephrology) 7/2020		**** Drs. Chappell & Shah (Nephrology) 7/2020

Line 24:		Line 34:
	** '''Symptomatic or /COVID positive or HepB positive - HD in ED'''		** '''Symptomatic or /COVID positive or HepB positive - HD in ED'''

	*~~ED Flow~~		STOP HERE
			* OLD PROCESS - no longer active as of 3/29/21
	** call from Dialysis Area Clerk to OCN --> OCN to place pre-arrival note		** call from Dialysis Area Clerk to OCN --> OCN to place pre-arrival note
	** Pt arrives with "dialysis ticket" (given by dialysis team prior to previous DC) stating here for scheduled emergent HD		** Pt arrives with "dialysis ticket" (given by dialysis team prior to previous DC) stating here for scheduled emergent HD
Line 32:		Line 43:
	** Symptomatic/COVID positive/Hep B - A15, R19, Tra1		** Symptomatic/COVID positive/Hep B - A15, R19, Tra1
	*** Patients getting dialyzed in the AED will be placed on teams; the team ONLY places DC order (no note necessary)		*** Patients getting dialyzed in the AED will be placed on teams; the team ONLY places DC order (no note necessary)

	*Post Dialysis		*Post Dialysis
	** After dialysis completed, HD nurse documents:		** After dialysis completed, HD nurse documents:
Line 43:		Line 53:

	----------------------------------------------------------------------------------------------------------------------------------		----------------------------------------------------------------------------------------------------------------------------------
	~~OLD PROCESS from 12-2017~~
	~~#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.~~

Bchap23 at 20:32, 16 July 2020

2020-07-16T20:32:30Z

← Older revision		Revision as of 20:32, 16 July 2020
Line 7:		Line 7:
	***** During daytime hours, SW may be able to assist (there is one HD social worker)		***** During daytime hours, SW may be able to assist (there is one HD social worker)
	**** If patient just had HD, can send outpt test to MLK or Keck with ~24 hour TAT		**** If patient just had HD, can send outpt test to MLK or Keck with ~24 hour TAT
	**** If Pt requires HD in <24 hours, patient may need ED dialysis ~~or admission~~		**** If Pt requires HD in <24 hours, patient may need ED dialysis
	**** If nephrology feels admission is warranted for HD, then '''rapid COVID test may be ordered ~~ONLY if it avoids an admission~~''' (eg, ~~negative test means patient~~ can go back to their dialysis unit) ~~or is necessary~~ for ~~the~~ admission ~~(Dr. Mahajan 6/2020)~~		**** If nephrology feels admission is warranted for HD, then '''rapid COVID test may be ordered''' (Dr. Mahajan 6/2020)
			***** If rapid test is negative, they can be discharged (and go back to their dialysis unit)
			***** If positive, will be needed for admission
	**** Drs. Chappell & Shah (Nephrology) 7/2020		**** Drs. Chappell & Shah (Nephrology) 7/2020

Bchap23 at 19:29, 16 July 2020

2020-07-16T19:29:15Z

← Older revision		Revision as of 19:29, 16 July 2020
Line 3:		Line 3:
	* Patients with assigned dialysis centers exhibiting symptoms or with a new COVID diagnosis		* Patients with assigned dialysis centers exhibiting symptoms or with a new COVID diagnosis
	** Contact their dialysis center immediately to see if they can be placed in the COVID HD cohort		** Contact their dialysis center immediately to see if they can be placed in the COVID HD cohort
	*** If they cannot cohort~~, consult social work and~~ nephrology to begin contingency planning		*** If they cannot cohort:
			**** Consult nephrology to begin contingency planning
			***** During daytime hours, SW may be able to assist (there is one HD social worker)
	**** If patient just had HD, can send outpt test to MLK or Keck with ~24 hour TAT		**** If patient just had HD, can send outpt test to MLK or Keck with ~24 hour TAT
	**** If Pt requires HD in <24 hours, patient may need ED dialysis or admission		**** If Pt requires HD in <24 hours, patient may need ED dialysis or admission

Bchap23 at 22:10, 13 July 2020

2020-07-13T22:10:47Z

← Older revision		Revision as of 22:10, 13 July 2020
Line 25:		Line 25:
	** MSE - "Pt here for emergent HD; no other medical concerns; hemodynamically stable for HD"		** MSE - "Pt here for emergent HD; no other medical concerns; hemodynamically stable for HD"
	** USA takes to Transitional Dialysis Unit (5 West Room 10) if COVID and Hep B negative		** USA takes to Transitional Dialysis Unit (5 West Room 10) if COVID and Hep B negative
	*** Label as AD1 or AD3 in ~~Orchid~~		*** Label as AD1 or AD3 on the tracking board in FirstNet
	** Symptomatic/COVID positive/Hep B - A15, R19, Tra1		** Symptomatic/COVID positive/Hep B - A15, R19, Tra1
	*** Patients getting dialyzed in the AED will be placed on teams; the team ONLY places DC order (no note necessary)		*** Patients getting dialyzed in the AED will be placed on teams; the team ONLY places DC order (no note necessary)

Bchap23 at 22:10, 13 July 2020

2020-07-13T22:10:06Z

← Older revision		Revision as of 22:10, 13 July 2020
Line 25:		Line 25:
	** MSE - "Pt here for emergent HD; no other medical concerns; hemodynamically stable for HD"		** MSE - "Pt here for emergent HD; no other medical concerns; hemodynamically stable for HD"
	** USA takes to Transitional Dialysis Unit (5 West Room 10) if COVID and Hep B negative		** USA takes to Transitional Dialysis Unit (5 West Room 10) if COVID and Hep B negative
	*** Symptomatic/COVID positive/Hep B - A15, R19, Tra1		*** Label as AD1 or AD3 in Orchid
			** Symptomatic/COVID positive/Hep B - A15, R19, Tra1
	*** Patients getting dialyzed in the AED will be placed on teams; the team ONLY places DC order (no note necessary)		*** Patients getting dialyzed in the AED will be placed on teams; the team ONLY places DC order (no note necessary)