View source for Harbor:Expedited Work-up Clinic (EWC)

*The Expedited Workup Clinic (EWC) is an option for patients who are stable but require close outpatient follow-up for further diagnostic evaluation (ex. uncharacterized mass, anemia, etc). These are patients that would have been admitted otherwise, but are clinically stable. The EWC is for patients who do not have a primary care provider and must have reliable contact information.
* '''Depart --> ED Post Visit Plan --> CCC-HAR --> free text in the "for Referral" box'''
*Must have reliable contact info, confirm phone number and address
*Ideal candidates are those patients that would be admitted in the absence of EWC, and '''do not have a primary care provider.''' Patients must have '''reliable contact information to attend this clinic.'''
 
*Clinical criteria:
** '''New onset ascites''' New diagnosis and first presentation of ascites. Requires paracentesis performed in ED to rule out infection, SAAG >1.1, transaminases < 3x normal, rapid HIV, CBC, lipase, CMP. No referral for therapeutic paracentesis alone, No evidence of pancreatitis or biliary obstruction.
** '''Anemia (Hgb< 8g/dL on initial presentation)''' Requires CBC, peripheral smear, CMP, rapid HIV, ECG, CXR, type and screen No evidence of pancytopenia, HIV, leukemia, active GI/GU bleeding, or evidence of hemolysis. Patients with suspected gynecologic etiology should be referred to the GYN service. Post transfusion CBC required.
** '''Weight loss, unexplained >10% within 1 month or >15% in 6 months'''  Requires CBC, CMP, ECG, CXR, rapid HIV. Patients with prior imaging must have actual images or be instructed to retrieve images  prior to clinic appointment.
** '''Undiagnosed mass (excluding primary breast[BDC], brain[NS], renal/testicular[urology], head and neck masses[ENT])''': Requires results or radiographic imaging to confirm presence of mass. Patients with prior imaging must have actual images or be instructed to retrieve imaging prior to clinic appointment. Send CBC, CMP, PT/INR, HIV on all patients. 
** '''New onset pleural effusion''' Requires thoracentesis, CMP, CBC, serum amylase, LDH, and pleural fluid analysis (predominant lymphocytic effusion or high suspicion for Tuberculosis must be admitted). Chest CT only if immediately clinically indicated (ie. suspicion for pulmonary embolism).

*Patient is stable (T< 38.3c, HR<100, RR <24, BP >110/50, BP <180/110, pulse ox >92% on room air, oriented x 4)
*Able to be seen in 2-10 business days without significant risk
*No ACTIVE co-morbidities (ie infection, CAD, CHF, stroke, metastatic cancer, renal failure, dyspnea).

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