Harbor:Main: Difference between revisions
 
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==YAFT (Young Adult FastTrack 21 - 25 y/o ESI 4 & 5)==
===YAFT (Young Adult FastTrack 21 - 25 y/o ESI 4 & 5)===
* Patients 21-25 years of age and ESI 4/5 are to be added to PED track and sent to the PED WR after triage/MSE.
* Patients 21-25 years of age and ESI 4/5 are to be added to PED track and sent to the PED WR after triage/MSE.
** YAFT will be open at all times  
** YAFT will be open at all times  

Latest revision as of 17:45, 27 January 2026

This is the main page for Harbor-UCLA emergency department; See Pediatric ED for the main Harbor pediatric page.

Admin Updates

Frequently Utilized Resources

  • Asthma (for QIP): Symbicort preferred (formeterol – long-acting B-agonist + budesonide – inhaled corticosteroid), 2nd line is Advair (salmeterol + fluticasone); be sure to refill their controller medication AND the albuterol (if needed). We fall out if they fill more albuterol Rx’s in a year than their controller medication. If prescribing albuterol, do not give refills (you get 200 puffs!).
  • Patient Relations Representatives (PRR) 3p-2a, 7days a week – call Registration for PRR who can help empanel into DHS or change empanelment/network in real time in the ED. PRR can come to bedside to meet with patient or send patient to Registration Windows. During business hours, send patient to Patient Relations Office in Rm 1-B-1.

Triage/RME/Surge Team

Specialty Care/Consults



Disposition



Diagnostics

  • Synapse got a new look. See link for details. A one-page intro guide are available on DHS SharePoint
    • Alt+C still works to compare studies.
    • Open the PowerJacket (folder icons) and then you can pull up the read on 'reports'. Click the dropdown to switch from 'report' to 'notes' to find a free text prelim read.
    • Change your default settings to what PowerJacket looks like and select ‘Notes’ and ‘Reports’ to always open so you can see prelim and final reads, respectively.



Legal/Quality Improvement/Safety

  • Safety
    • Active Threat in the ED
      • Situational awareness
        • Stand between door and patient
        • Ensure patient is gowned
        • Be aware of long stethoscope, lanyard, long hair, etc
        • Panic buttons at nursing stations/router
        • Run & scream for help
      • Hospital Codes
        • Gold x111 - combative/agitated patient
        • Gray x64450 - combative/agitated NON-patient
        • Silver x111 - weapon, active shooter, hostage

PED

ED to PICU

  • When patients are ready to be transferred to the PICU, the patient has been discussed with the admitting team, the request for admission has been placed thus transferring patient care responsibilities to the PICU team, and the PICU resident has dropped their orders.
    • The PED RN will call the PICU resident at x65454 to let them know the patient is ready to be moved. The PED nurse and Pediatric resident can discuss the need for the provider to be present for the transportation. If either feel the provider needs to accompany the patient for transport, the PICU resident will come to the PED to assist with patient transport to the PICU. Otherwise:
      • 1. The PICU resident should ensure PRN sedation medications are ordered so they can be utilized by the PED nurse/transport team.
      • 2. The PED RN can call the PICU resident at x65454 during transport if and additional emergent verbal orders are needed.
    • The patient's primary PED RN and RT transport the patient to the PICU (as is done for adult patient in the AED).
    • If it is deemed that a provider is needed and the PICU resident is not available, they should call their attending to assist with the transport.
    • If the patient is hemodynamically unstable, the PICU attending should evaluate the patient in the PED prior to transport to the PICU.

Padlipsky/Evans 1/26/2026


YAFT (Young Adult FastTrack 21 - 25 y/o ESI 4 & 5)

  • Patients 21-25 years of age and ESI 4/5 are to be added to PED track and sent to the PED WR after triage/MSE.
    • YAFT will be open at all times
    • ESI will be assigned in triage, orders should be placed, and pain medications can be given.
    • If beds are open in the PED and the patient will be roomed quickly, labs/xrays will be done in the PED. If the PED is busy and the patient will be waiting in the PWR, the orders placed during the MSE will be done by tasking and then the patient will be sent to the PWR.
    • Reassessment after pain medication will be done in the PED
    • MSE provider will indicate on the track under nursing comments (“no PED”) if the patient is not appropriate to be seen in the PED (psych, OB triage, aggressive/angry patients, etc.). These patients will be registered after triage, go to tasking, and stay in the AWR after tasking.
    • If the PED WR is full, these patients should still be moved to PWR on the track but can wait in the AED; this should be indicated on the tracking board under nursing notes (“in AWR”).
  • The 21–25-year-old patients will then be pulled from the PED WR track and can be placed in any room in the PED. The PED Charge RN will decide the most appropriate room for the patient.
    • Ideally, P8-11 will be held open for FT (ESI 4/5) patients >25 y/o and should generally be assigned to Purple or Green teams unless the PED census is low and there is an adult-trained attending in the PED.
    • The young adults sent to the PED WR will be registered in the PED by the registration staff near the PED.
  • ESI 3 21-25-year-olds can be seen in the PED under the following process:
    • Once an ESI 3 21–25-year-old’s workup is completed and they are marked Teal (stable, easy dispo), the senior EM resident or attending in the PED will look through these patients and determine if they can be seen in the PED for disposition.
    • ESI 3 Young Adults should not be brought to the PED until their workup is completed AND the patient is discussed with the PED attending or senior resident.
    • If no one is marking the ESI 3’s as TEAL, the PED Senior resident or the PED attending should go through the list of 21-25 year old patients ESI 3’s in AWR and mark which ones are appropriate to come to the PED. Their workup should be complete, and deemed appropriate for the PED.
    • If the PED attending or senior resident feel the patients are appropriate for the PED, they will indicate in the nursing comments “OK PED” and let the PED Charge RN know so they can bring the patients to an open PED room.
    • If P8-11 are being utilized for >25 y/o FastTrack patients, we should revert to prioritizing pediatric patients if:
      • There are 5 or more pediatric patient in the PWR, or
      • The wait to be seen for patients in the PWR is >2 hours.
    • Any patients over the age of 20 that require admission will be admitted to adult services, not to pediatrics.
  • Specifics related to PED Provider Staffing
    • Conference Coverage:
      • On Thursdays, until 1 pm, the ESI 4/5 21–25-year-olds will still be placed in the PED but will be assigned to the Purple or Green teams unless the PED attending has capacity (and residents) to see the patients.
    • Attendings:
      • If a Pediatric-trained PEM fellow is the attending (Dr. Lathia), the 21–25-year-old ESI 4/5 will still be put in the PED rooms but the PED resident seeing the patients will present the patient to one of the AED attendings.
      • If the PED attending is pediatric trained (Drs. Padlipsky, Saidinejad, and Escalona) and they are not comfortable with the patient’s presenting issue (not in their scope of practice), the patient will be presented to an AED attending.
      • If there are 21-25-year-old ESI 3 patients that are deemed appropriate for the PED, they will be presented to an Adult attending if the PED attending is a pediatric-trained PEM fellow.
    • Residents:
      • An EM R4 can independently disposition ESI 4/5 adult patients with the approval of their on-shift PED attending.
      • Although pediatric residents should prioritize seeing <21 y/o patients, they can see <25 y/o ESI 4/5’s patients who are within their scope of practice. These should all be seen by the attending to ensure appropriate management.
      • Pediatric-trained PEM fellows can only see patients under 21 years of age.
      • Family medicine residents can see all ages, but they have a requirement of seeing 50 pediatric patients during their month in the PED.
    • APP’s:
      • NP’s in the PED (Long and Jazmin) can only see patients under 21 years of age.

Updated by Dr. Padlipsky and Dr. Chappell 1/26/2026

Welcome to Harbor-UCLA (Orientation)

Old Material


Administrative duties

Administrative resources

Harbor ED policy manual

ED attending on call plan

Harbor Legal

Managing your Patient

General

On shift (PC) Cheat Sheet

Paging consultants

Phone numbers

Radiology directory

Tests & Orders


Radiology

Radiology Hours

[Radiology Directory]

STAT MRI

Interventional Radiology (IR)

  • When discussing the case with IR, the ED provider needs to clarify if the patient will require sedation for the procedure and communicate this plan to the ED bedside nurse
  • Two pathways from the ED:
    • Patient requires sedation for the procedure – they will be recovered in the PACU
      • If patient is being discharged, the patient will be DC’d from PACU
      • If patient is being admitted, the patient will go to their assigned inpatient room or board in the PACU
    • Patient does not require sedation for the procedure
      • They will be returned to the ED after the procedure

US & QPathE

  • QPathE Login link
    • Login using e# and associated password
    • Double-click the exam
    • Click "edit" at the top of the page
    • Enter MRN in the "patient ID" box
    • in "comments" enter trauma FAST
    • Click save at top of screen


Contrast

Upload Outside Films to PACS

  • Get form from clerk
  • Put patient sticker on Form
  • Check "Import"
  • Sign

Get Images on Disc (For DC or Transfer)

  • Same as upload EXCEPT
    • Check "Export"
    • Write time frame on form you want studies from

Blood products

Antibiogram

Finding Equipment/DME

ED supplies A-Z

Procedures

Special patient types

Code Activations

Placement patients

Psych Patients, Code Gold, & Exodus

Scheduled dialysis patients in ED

Sexual Assault/STI Exposure (SART)

Occupational Exposure

Harbor Radiation Precautions

NFL/NBA Injured Player/Staff Protocol

Substance Use Disorder (SUD) Treatment Options

Infectious Disease Threats

Social Work

Crown Checks

  • Screening L & D patients: If a pregnant person is brought back to the PED for an evaluation, it should be for active labor and the urge to push.
    • If the pregnant person has the urge to push, we are doing a crown check – that is looking to make sure the head is not visible. We are not doing a complete internal exam. If no head is visible and everything else seems okay, we do a quick MSE note and the patient is sent upstairs to L & D after the nurses call up and let them know they are coming up.
    • Caveats:
      • If the pregnant person is having contractions and the baby appears to be premature below 37 weeks (especially less than 32 weeks) and delivery seems to be imminent (water broke, contractions very close together, etc) consider calling OB batch as the baby can be born through only a partially dilated cervix with little pushing. We do not want this to happen in the elevator.
      • If the birthing person has had multiple pregnancies/deliveries, the baby can be born rather quickly; be more conservative in your clinical judgement to transfer to OB.
      • Vaginal bleeding – if the birthing person is having significant vaginal bleeding, then OB should be called down to us for evaluation – using the OB batch pager gets them down quickly.
      • Please use your medical knowledge to determine the risk to the birthing person and the chances the baby could be born in the elevator. If in doubt call OB batch page for OB to come down to evaluate the situation (I frequently have them come down for micropremies to check to see how imminent delivery is rather than sending upstairs with the risk of delivering in the elevator).

Patients requiring ED D&C

  • If an ED patient requires a dilation and curettage (D&C) for indications such as spontaneous miscarriage or retained products of conception, it can be performed in the adult or pediatric ED’s in collaboration with the OB/GYN team. Once the patient has been consented by the OB/GYN team, they can administer a bedside paracervical block and provide additional analgesia within their scope of practice. If the patient requires (or requests) procedural sedation to facilitate the procedure, this should be discussed with the ED Attending. The ED Attending will determine whether procedural sedation is feasible based on the ED team's capacity and the current state of the department.
  • The estimated sedation time may vary based on the clinical situation, but it is generally expected to be 10-15 minutes. If adequate sedation or analgesia cannot be provided by OB/GYN at the bedside, the ED team is unable to perform procedural sedation, or sedation is expected to take >20 minutes, the procedure should be performed in the operating room with Anesthesia. All decisions regarding the location of the D&C should be patient-centered and involve direct communication between the attending physicians.
  • For elective abortions, have the patient call 1-877-CARE121 8am-5pm M-F and provide patient handout "Pregnancy Options" under Custom Patient education.

Patient Disposition

Discharge

ED Follow-Up Options

DC with meds in ED

  • Eye drops (vanco & tobra) and STI prophylaxis for home
  • HIV prophylaxis for sexual assault patients (raltegravir and Truvada)


Transportation Needs

Social EM resources

Admission

Admission Guidelines

Interqual Criteria Tips

Interqual Override Notes

Right level of care

Neuro Obs & RLA Transfers

OBS & CORE


Dialysis in the ED

Other Disposition

Documentation

Disaster & Surge

Resident Education

See Also

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