Harbor:Main

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.

Disaster & Surge

Triage/RME/Surge Team

Specialty Care/Consults



Disposition


Diagnostics


  • Synapse User Guide: A one-page intro guide is 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

YAFT + BRIDGE

Crown Checks in PED

OB Activation Pages & Screening Pregnant Patients in the ED

  • General Principles:
    • Patients with a gestational age of >14 weeks seeking obstetric care who present to the emergency department are registered at the router and guided directly to labor and delivery (L&D) for initiation of their medical screening exam (MSE). Patients with active labor, the urge to push, and/or significant vaginal bleeding will be briefly evaluated in the pediatric ED to ensure delivery is not imminent (crown check). If the patient is felt to be at risk for transport to L&D, the obstetrics team will evaluate the patient in the ED.
    • All patients who are being sent to L&D from the ED after MSE require a discharge order (discharge to L&D) from the emergency department. The exception to this is for patients born out of asepsis (BOA) in which the birthing person and newborn are admitted to appropriate levels of care.
    • The OB Batch Page rapidly mobilizes a multidisciplinary team for the urgent/emergent evaluation of a pregnant person with a high-risk condition.
    • Exact gestational age may not be known. Emergency Medical Services (EMS) Clinicians and the Emergency Department (ED) will use their best judgment based on the available information and exam to determine viability (palpable uterus at umbilicus or above). When uncertain, the OB Batch page may be activated to ensure the necessary resources are immediately available.
  • Transferring Pregnant Patients to L&D from Router Desk:
    • Patients 14 weeks pregnant and greater can be sent directly to L&D for further observation and management.
      • Per Labor and Delivery, Perinatal Specialty Manual Policy #470, Triage/Admission criteria for L&D:
        • DHS established patients can be seen in L&D at any gestational age once they have an established intrauterine pregnancy on ultrasound and up to 6 weeks postpartum.
        • Non-DHS established patients with a GA ≥ 14 weeks may be seen on L&D.
        • Non-DHS established patients with a GA < 14 weeks are referred to the ED for evaluation.
      • These patients are quick-registered by the Router RN who then notifies L&D (x66262) of the patient.
        • If there is concern for active labor, the patient will be taken to the PED for a crown check.
        • If there is no concern for active labor, the patient is escorted to L&D by a member of the ED staff. If the patient is familiar with L&D, they can decline transport.
          • The patient is then departed to “OB Triage” (in the “discharge disposition” of the “depart process”).
  • Criteria for Screening Laboring Patients in the Pediatric Emergency Department (PED):
    • Pregnant patients >20 weeks gestation who present to the router desk or are transported by EMS who are in active labor, have the urge to push, and/or have significant vaginal bleeding.
    • Steps for Screening Patients in the PED:
      • Provider performs a crown check.
        • This involves making sure the head is not visible at the introitus. An internal exam is not performed.
      • If the patient is not crowning, a MSE note is completed, ED nurse to L&D nurse signout is completed, and the patient is discharged from the PED to L&D.
      • If the head is visible on the crown check, there is significant vaginal bleeding, or you anticipate a complicated or imminent delivery, utilize the OB activation page.
      • Consider using the OB activation page if the patient is in active labor and multiparous, multiple gestations, or labor is premature (< 35 weeks). Be conservative in your clinical judgement to send an OB activation page.
    • Please use your medical judgement to determine the risk of delivery during transfer to L&D. If in doubt, send the OB batch page for OB to evaluate the patient in the ED and make the determination for most appropriate location for further care.
  • OB Activation Page Recipients: OB Attending and team, NICU Attending and Delivery Team, Anesthesia Attending and team, Respiratory Therapy, Emergency Department RN Managers, Social Work.
  • OB Trauma Activation Page Recipients: same as above plus the trauma team.
  • OB Activation Page Content: Room location, maternal age, gestational age, and number of fetuses.
    • OB Activation Page should be used in the following scenarios:
      • Pregnant person > 20 weeks presenting with heavy vaginal bleeding, severe abdominal pain, decreased fetal movement, recent seizure activity, hypertensive emergency, sepsis, loss of consciousness, hemodynamically instability/shock, or at the discretion of the ED attending physician.
      • Any pregnant person who arrives in active labor and crowning on external exam or with an expected complicated or imminent delivery.
        • Consider OB activation page if the patient is in active labor and multiparous, multiple gestation, or labor is premature (< 35 weeks). Be conservative in your clinical judgement to activate OB resources.
      • Any newborn BOA.
    • OB Trauma Activation should be activated for the following scenarios:
      • Pregnant person > 20 weeks gestation activated as or upgraded to a TTA1 or TTA2.
      • Pregnant person > 20 weeks gestation involved in any traumatic incident (not meeting any trauma criteria) with any of the following symptoms: abdominal pain, vaginal bleeding, decreased fetal movement, seizure activity, hypertensive emergency, loss of consciousness, hemodynamic instability/shock, or at the discretion of the ED attending physician.
  • Urgent Consultations to OB/GYN Service:
    • An OB consult should be placed in Orchid for any pregnant person > 20 weeks gestation presenting after a traumatic incident without any symptoms (no abdominal pain, vaginal bleeding, LOF, contractions, decreased fetal movement). OB will urgently assist in assessment of the fetus and mother until medically cleared and may perform further monitoring as needed.
    • An OB consult should be placed in Orchid for any pregnant patient > 20 weeks presenting with high-risk symptoms (mild to moderate vaginal bleeding, non-severe abdominal pain, severe range blood pressure, signs of infection, or at the discretion of the ED attending physician).
    • Consider OB consultation for any cases in which there is uncertainty regarding the need to utilize the OB activation page. If the patient is en route via EMS, consider a direct phone call to the L&D Attending to determine if urgent OB consult or activation page is the best next step.
  • On-call OB can be reached by paging OB/GYN via autopage in FirstNet, calling the OB senior (x64372), or calling the OB attending (x64373).
    • OB/GYN CISCO PHONE NUMBERS:
    • L&D ATTENDING x64373
    • OB/GYN SENIOR RESIDENT x64372
    • OB/GYN JUNIOR RESIDENT x64357
    • OB/GYN MIDWIFE x64375
    • GYN UC/ATTENDING x64376

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

DCFS Unsafe Discharge

  • This is NOT an AMA or 5585 (only for danger to self/others, grave disability)
  • Social Work - x66990 - have them come to the bedside; can help liaise with DCFS
  • DCFS for child protective custody when Discharge to the available caregiver/home would expose the child to abuse, neglect, abandonment, or other serious harm
    • Reporting to DCFS
    • Physician should speak with DCFS to express the clear safety concern
      • “The parent is requesting immediate discharge. The treating team believes discharge to this caregiver/location is unsafe because [specific facts]. We need an immediate disposition/custody determination.”
      • Ask whether DCFS is assuming custody, arranging an emergency placement, or requesting law-enforcement involvement.
      • Ask for the worker's name, office, callback information, referral/case identifier if available, response timeframe, and whether DCFS is responding to the hospital.
      • Once protective custody is established, document exactly who has legal custody and under what authority. Do not chart “DCFS hold” merely because a hotline report exists.
    • Consider involvement of the SCAN Team
    • California's child-welfare process can proceed under WIC §300 when abuse/neglect places the child within juvenile-court jurisdiction.
  • Risk Management - x----, p----; simple notification if escalation is needed
  • Security/Sheriffs - Securitas supervisor x-----; Sheriffs supervisor x------; on standby
    • If the caregiver attempts to remove the child before DCFS resolves an imminent safety concern, escalate to the Sheriffs for lawful temporary protective custody when parental action creates an imminent, significant risk of serious harm.
    • The purpose is to obtain lawful protective-custody authority. Collaboration between medical staff and law enforcement should remain focused on the child's safety and legal status.
  • Physician Documentation
    • Document objective facts, not simply unsafe home:
      • Specific hazards/allegations
        • credible abuse, caregiver unable/unwilling to protect, immediately hazardous living conditions, abandonment, or caregiver impairment
        • DCFS considers immediately hazardous living conditions, inability to meet immediate needs, inability/unwillingness to protect, threats of serious harm, and concern that a family may flee.
      • Why they create risk to this child
      • Who was contacted and when
      • DCFS disposition/instructions
      • Current legal custodian, who may consent for care
      • Discharge/placement plan
    • Sample Note
      • Disposition/safety concern: Patient is [medically cleared / continues to require medical care]. Discharge to the currently proposed caregiver/home is not considered safe at this time because: [specific objective facts and resulting risk to child].
      • Parent/guardian requested to leave with patient at [time]. I explained the specific safety concern [document in layman's terms] and that a child-protection evaluation is underway.
      • DCFS: Report/contact made at [time] with [name/identifier]; referral/case number [if provided]. DCFS advised [paraphrase conversation] and plans [response/placement if actually stated].
      • Hospital team: Social work [name], risk/legal [if contacted] notified.
      • Law enforcement/security: [agency/officer/time/reason contacted and action taken].
      • Current legal custody/status: [parent / DCFS / law enforcement / court order / unclear—being verified].
      • Patient will not be discharged until a legally authorized safe disposition has been established.

Metabolic Care Plans

  • Can be viewed by clicking the link above or clicking the "change filter" button in the documents section of M-page and selecting "Advance Care Planning/Complex Care Plan"

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

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

Resource Pathway (former placement pathway)

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

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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