OVMC SENIOR Guide

FYIs and Tips

​

In Clinic

• Visits in general: Think of every visit as a chance to vaccinate. Check and clearly document immunization status. Pay attention to the requirements for children 12 years and older, including TdaP, MCV4, and HPV. Nurses should have access to the CAIR system.

• Translation services: Many of the patients are Spanish-speaking only. If you need a translator, we have 1) in-person Spanish only 2) certified RNs Spanish only 3)video on iPad translator for any language 4)phone translators for any language.

• Float book: If you have a lab/image study, a telephone check, or a clinic return visit that you want someone to keep track of, fill out a float book page. Make sure to get the patient’s name, MRN, date of birth, working telephone number, and primary language spoken. Try to put as much relevant information with if/then statements about what you want followed-up and done. Let the day senior or night senior know after you’ve put the form into the float book, especially if it is an urgent matter. Float book is only for following up on results. It’s not intended for general check-ins like seeing if a patient is feeling better, confirming appointments, or making sure they have insurance.

• In general follow up and referrals should be done by PMDs.

• All teaching patients on 4C should be seen by residents in the order they arrived, regardless of which clinic/specialty the patient is assigned to. This means no cherry-picking just same-day/urgent care patients. 

​

In the ED

• Decision-making: All patients must be staffed with the ER attending. But if you have ANY questions or concerns about the plan, you can discuss with the pediatric attending on call. All patients that are being admitted should be discussed with the on-call attending also, even if the patient is being transferred to an outside hospital.

• Available subspecialists at OV: For pediatrics, we do not have vascular surgery, neurosurgery, cardiac surgery, or PICU. Patients needing these must be transferred. Sometimes patients >14 yo can go to the MICU. We do not have orthopedic surgery emergent/urgently available either.

• Radiology: Afterhours, there may be a moonlighting radiologist in the ED reading room (by US and Xray). Always look at images first and knock on the room door to get help with reviewing images. If no one is moonlighting, US ROC provides radiology service. Reads are quickly loaded into synapse and the ROC website. Use the posted login in the ED to access the ROC reads. If no read is up, call US ROC to get the read. 

​

YOU MUST CALL AN ATTENDING ABOUT

•       Code Blue, RRT or Code Stroke       

•       Transfer to ICU or SDU

•       Any CRITICAL RESULT not on sign out (lab, Xray, EKG, Echo etc.)

•       Unexpected transfusion

•       Failure in achieving an expected treatment plan (e.g. delay in urgent consult, diagnostic study, urgent medication, higher level of care transfer, etc.)

•       New seizure, paralysis or stroke

•       Attending staff (any) request that the on service attending be contacted  

•       Error resulting in harm (fall, medication, delay)

​

*Note: If you have ANY questions when you are on at night PLEASE call the pediatric attending!

​

​

Resources/How-To

​​

• Bronchiolitis & HFNC Clinical Pathway (ED and Inpatient)

  • Click the PDF icon to view the clinical pathway​

​

• LAB USER GUIDE It’s a quick and easy way to look up details for any lab test you’re ordering, including the type of tube needed, how the sample should be collected, and any special instructions.

​

• Clear a Psych patient

  • Medically clear the patient and then contact psychiatry to evaluate the patient

​

• Care for a neonate with jaundice over the weekend:

  • Weekend outpatient bilirubin workflow​

​

• Decide what to do about a broken bone…

  • Podiatry—sees all foot complaints, any age

  • Plastics/Hand—sees all hand complaints, older than 15 yo

  • Steps to successful LAC-USC ortho referral:

1.     Make sure patient has elbow fracture or growth plate fracture and cannot be seen by at OV by hand, adult ortho, podiatry, or pediatrics (see flowsheet)

2.     COMPLETELY fill out LAC+USC Medical center Expedite Referral Request (sheets in float book) for acute pediatric injuries.

3.     Give family:

a.     CD with images (ask XRay tech to make this)

b.    Map to LAC-USC

c.     Copy of referral form

d.    Copy of demographic and insurance information (ie the patient’s Facesheet)

4.     Fax the following to 323-409-3703

a.     Referral form

b.    Copy of demographic and insurance information (ie Facesheet)

5.     Call to confirm fax went through at 323-441-8072

6.     Leave referral form and COPY OF NOTE in front of float book, ensure that an attending gets it the next day to enter in referral processing system

**Patient will not get phone call confirmation of appointment and should just go to appointment.

​

• Admits:

  • Who is admitted to peds?

    • Age <21 years. Ages 18-21 years need medicine co-follow.

    • Co-follow all pediatric surgery, ENT, plastic surgery patients (you can put in orders but discuss with surgical teams before writing if non-emergent. We also have to agree on discharge of patient)

    • All others are peds primary with subspecialists consulting

  • When admitting…

    • Notify pediatric attending on call

    • Notify pediatric floor nurses at x4831

​

• Transfers: When a patient must be transferred (for insurance or medical needs) call the Medical Alert Center (MAC), which is the county’s transferring system.

1.     Call MAC at 323-869-0587

2.     Have all paperwork with you before you call. They will ask everything from story to labs, latest vitals, and demographic info.

3.     Write down the name and MAC ID number of the person helping you

4.     After talking to the MAC operatory, they will connect you with a possible accepting physician. Present the patient to this physician as would to your attending.

5.     The physician will accept or not and MAC will help you through the process. They will arrange transport for you and update you on pick up time and where the patient is being taken.

6.     Before the patient is transferred, you must fill out 2 forms: a consent for transfer that must also be signed by parents, and a checklist for documents going with the patient. Give these to the nurse caring for the patient.

7.     Keep the nursing staff updated on expected time of transfer so they can sign out the patient and prepare all needed documents. When you know the accepting physician name and patient room number at accepting hospital, document these things and the MAC case number in a SOAP note in the patient’s chart.

​

• Setting up Follow-up from the Emergency Room

  • How to find out if the patient can be seen at Olive View:

    • Go to “Utilization Review” tab under the left sided “Menu” tab of their chart:

    • Look at “Insurance Information”: if any of the below are listed under “Primary” they can follow up with pediatrics at Olive View:

    • MEDI-CAL RESTRICTED BENEFITS 402                                   aka Emergency Medi-Cal

    • MEDI-CAL RESTRICTED BENEFITS 406                                   aka Emergency Medi-Cal

    • MEDI-CAL MANAGED CARE LA CARE (DHS) 615                  aka Olive View Medi-Cal

    • MEDI-CAL MANAGED CARE LA CARE (DHS) 644                  aka Olive View Medi-Cal

    • SELF PAY OUTPATIENT 000                                                       aka self-pay

    • Any questions about insurance, call Utilization Review at extension 4890.

  • If they have one of these insurances you can email the peds clinic to set up an appointment:

    • Go to the “Communicate” tab on the top middle of the chart window.

    • Send the new message to “OVM Pediatrics ED/UC Urgent Care Follow Up”, press enter.

    • You may have to look for this contact by clicking the “Pool” button, then add the contact.

    • Send a quick message about when you want them to follow up, the clinic will do the rest. Click the “Patient Needs Appointment” box bottom left before you send the message.

  • Doesn’t have one of these insurances but want/need to follow up at Olive View Pediatrics? Here is how the parents can change their Medi-Cal Insurance:

    • Give them a "pink sheets", available in ED and Clinic.

    • Have parents call the Olive View Patient Service Center at (818) 364-3800 or they can come in person to the office.

 

 

 

 

Last modified: September 2021