Kaiser WLA

N

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Info

Req

• Acute stroke: .nihss & .telehealthconsent
• Pna: .curb65 & 72hr FU appt (ask clerk to sched appt)

Deaths

• Document whether or not "coroner's case", if yes you MUST contact the coroner.
• If non-member, document whether you contacted PMD and/or POMD to sign death certificate.
• If member, leave message on PMD voicemail, generally will sign death certificate.

Outpt

• Suture/abscess >13yo: follow up in UC, no appt needed.
• Suture <13yo: wound check and suture removal in peds clinic. Walk-in peds clinic 5-830. If parent calls before 7am they will get same day appt.
• Abscess <13yo: FU in ED
• Pt call 18009548000 schedule routine FU with their PMD (take several weeks).
• Clerk schedule FU appt if needed <2wks.
• Education classes: asthma, dm, depression, stress, bp, chol, wt mng, smoking cess. Pt call 3232983300 to enroll.

EPRP

Regional EPRP Direct IP Admit

• Intubated patients
• Bipap/Cpap
• Unstable patients transferred for HLC to ICU
• Sepsis
• DKA on insulin drips
• PE with hypoxemia
• Meningitis needing inpt abx
• Ischemic stroke w/ sig neuro def
• Hemorrhagic stroke not req Nsg intervent
• CAP - Class 5
• COPD exac req >6L O2 (over baseline)
• CHF exac in nonO2 dep pt (still hypoxic despite aggressive ED tx 4 hrs
• Chest pain where Kaiser CV CS req adm
• Nonsurg CT proven diverticlitis/febrile/ill/need inpt abx
• Acute MI ACS + enzyme / EKG changes transferred for HLC

WLA "ED MD Fast Pass" (in ED)

• Chest pain w nml EKG and neg trop, low risk
• pain syldromes (ex migraines), except sickle cell
• PNA Curb 65 1-2 w/ nml labs and no O2 req
• Asthma
• Blood transfusion up to 2U
• Htn OOC no e/o end organ injury
• DM OOC not DKA
• weak and dizzy w/ nml work up and no longer sx
• Vomiting, resolved/persistent
• UTI in elderly, af, not confused, not septic
• Psych
• Abd pain w/ neg work up
• DVT
• Social

WLA "MOD Fast Pass" (in ED)

• CVA, TIA
• syncope, cardiac or noncardiac
• hypogly on sulfonylurea
• any infxtn w/ ALOC, low BP, or elev lactate
• high risk CP with multiple risk
• PE without hypoxemia
• weak and dizzy with nml work up and still sx
• GI bleed
• uncontrolled afib (ex on a drip)
• SNF placement need apparent prior to transfer
• SOD takes all traumas

WLA "MOD Evaluation" (in ED)

• all else notlisted, pt sent to ED but MOD complete eval and decide adm vs tx/dc

CV

Stress Test

• Same day ETT: if nml working hrs, order and wait to be completed as an inpt.
• Next day outpt ETT: M-F, ask clerk fax treadmill req form and EKG to cards. Order "outpatient cardiology referral - treadmill - stat - comments low risk chest pain"
• Nuclear perfusion for low risk (baseline LBBB, cannot ambulate, etc.): ask clerk fax form. Dc order "PNL Lexi - stat - comment Low Risk Chest Pain Protocol". NM will contact pt to schedule.

Fx

Ortho fx clinic M-Sat starting 830a. RN or clerk schedule FU 1-2d of ED.
Soft tissue: outpt referral order.
Nasal fractures: ENT
other Facial fractures (includ mandible): Plastics

Heme

DVT

• Call inpt pharm x (assist lovenox initiation), off hrs ED RN will instruct on lovenox injct.
• Rx warfarin
• Leave msg coumadin clinic x to arrange Pt/INR FU

Nsg

• Clerk page ETAP operator (Nsg at KSunset closest)
• TBI + nml CTH + GCS >13: may stay if obs needed
• TBI + nml CTH + GCS <13: txf Nsg center for eval by nsg

Ophth

• recheck of FB removal, deep corneal abrasion, minor "red eye" do not req on call CS.
• Pt call 3238571163 730-8a to schedule own same day FU appt for M-F.

Ped

• Newborn: LAMC Peds hospitalist for ?
• Urgent Newborn: NOD (inhouse overnight)
• Peds <14yo adm: call LAMC peds hospitalist
• Peds ? and CS:
  • POD from 8am-9pm M-F and 9am-7pm Sat/Sun/Holiday
  • LAMC ped hosp outside of these hours
• Back-up peds: any CS req peds to come in to ED to eval.
• Teen ? and CS :
  • Back-up peds for teen admissions (14-17yo) 9pm-8am on weeknights & 7pm-9am on weekends/holidays (all other hours POD is paged)
  • POD for teen admissions 8a-9p M-F & 9a-7p Sat/Sun/Holid
  • 11pm-3am peds may ask MOD to assist with admission (peds must call MOD) and peds assumes care in AM

Psych

• SI must document "R45.851 - Suicidal Ideation/Suicidal Ideations" or "T14.91 - Attempted Suicide w Injury/Suicide Attempt" -> triggers list for care coordinator to contact pt

Urology

Painless Hematuria
- CT urogram: In ED if active painless bleeding AND only if pt has gross hematuria, sig drop Hct, or anemic from bleeding.
- if not active bleeding -> outpatient CT urogram & outpt urology referral
- 20 F 3way cath for irrigation.

Kidney Stones
- CT KUB
- Uric acid stones cannot be seen on KUB, must use CT
- urine strainer for dc pt's, urology WANTS stone for analysis
- Tamulosin preferred agent, if already on hytrin then no just keep them on it

UTI
- Urine Culture all recurrent UTI. (Many times it is not a UTI and the culture helps them when seeing the patient in clinic)

General
1. Our standard foley catheters are 16 F coudet catheters. If the patient has a prior stricture, surgery, TURP then do not keep attempting to place a larger catheter. This will just cause trauma and bleeding. Call urology. In the case of BPH a LARGER catheter may pass more easily
2. If a patient is post op, please do NOT have the RN's automatically place a foley in triage. This may be contraindicated after certain surgeries
3. Please DO NOT tell patients to go to urology clinic without an appointment. Send a referral or direct book the patient. Later the same day or the next day may be too soon. For example, a kidney stone patient should be seen in 2-3 days to allow time for the stone to pass. They won't change management if seen later the same day or the next day.

References

Information expressed here is not officially approved or endorsed by Kaiser or any associated groups. This is not official medical advice.