General Information

Emergencies at UCLA

To call a code blue, alert the nearest nurse and/or call #36 and say you are calling a pediatric code blue. You do not need to call the page operator for this. Note: even if you press a code blue bottom in the room, someone should still call #36. If you're worried about a patient but don't think it requires calling a code, you can also call a rapid response, which will alert the PICU on-call team, the charge nurse, and a respiratory therapist. Since the institution of the rapid response team (RRT), there has been a dramatic decline in the number of pediatric code blues.  To call a RRT, alert the nearest nurse or dial #36 with your location.​​

 

On the floor, the hospitalist attending will usually be present at the beginning of the rapid response to check in, but given there is often not an official role for the hospitalist attending, they may only be present at the beginning. Depending on the clinical situation and their other competing responsibilities, there may be times when a hospitalist attending is not present at a rapid response; however they are always accessible for support if requested by the resident team or any other team member. Please always feel empowered to reach out to your attending. 

 

For code blues, the hospitalist attending must always be present.

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Paging Acronyms and Etiquette

When nurses on the floor page you, there should be an acronym to let you know the acuity of the issue. These apply to the wards only, not the PICU.

Urgent: call back in 10 minutes

FYI: for your information, no need to call back

CTC: call to clarify

NCN: no call necessary

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Instructions for downloading Spok/Haiku on personal phone

1. Make sure you have the latest iOS software installed on your phone 

2. Download Intelligent Hub 

3. Log in with Mednet email, username, and password

4. It'll prompt you to log into your email account on your phone (Duo verification required) 

5. Install Spok and Haiku (delete the apps on your home screen if you downloaded them previously — this way, the UCLA authentication info will automatically populate via the Hub download) 

   1. Spok username should be your work phone #

 

Map to OR / Procedure Rooms: Map

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Lactation rooms for employees (Open 24/7)

• Room #B2-349, Door code 82020#

• Room #B790M, Door code not necessary

• Room #B706, Door code needs to be obtained from nursing admin (x79691) or NICU (x77565)

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Call Rooms

• 4th floor - 1 assigned to PICU resident/Fellow - 4406B. 1 assigned to NICU attending/ECMO attending - 4406G

• 3rd floor - one room assigned to Pediatric residents - 3211D

• 5th floor - 1 assigned to PICU Resident - 5206E. 2 assigned to Peds residents - 5406G and 5406D. 1 assigned to NICU resident -5515F. 1 assigned to NICU Fellow - 5515E. 

• 7th Floor - 1 assigned to Ped CT/ICU - 7406D

• B-level - 2 assigned to Peds residents- B714 -25and 26. 1 assigned to Peds Sub I/Hem-onc/ICU.

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EPIC Patient Discharge Instructions/Tips (can only view link from UCLA or VPN): https://lms.ccnet.ucla.edu/elearning/IP490htm/ 

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Zoom Rounds Tips (click here)

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How to file a SOFI Report (click here)

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Important phone numbers, aka hospital contacts (click here)

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Qgenda - checking which pediatric subspecialist is on call (click here)

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Guide to discharge orders (click here)

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Academics

 

Grand Rounds

Grand rounds are held every Friday in the Tamkin Auditorium on the B level (B130) from 8:00-9:00 AM.  Prompt attendance, as with the above, is mandatory.  Food is not allowed in the auditorium, but breakfast is set up outside the conference from 7:40-8:00 AM.  Attendance is monitored by evaluations filled out at the end of each conference.  Also, it's considered poor form to leave loudly during the question/answer period at the end of the presentation.  If you have to go, do so tactfully.  Otherwise, your attendings can wait till 9:05 am if it runs over (they should be in there anyway!).

Noon Conference

Pennington Conference Room (5265) every day from 12:15 PM-1:00PM.  All residents at UCLA, including ward teams, PICU, NICU (when not receiving their own lectures from NICU faculty), PCC, and electives, are expected to attend. 

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Rounds should end by 11:15 and by 11:45 residents should be wrapping up tasks and heading down to the cafeteria to get lunch before the 12:15pm start time. Residents turn off your chat and sign out additional urgent tasks / forward your pager to your attending during noon conference 

 

Please remember...

• Attend all conferences promptly out of courtesy for the speakers.

• Sign-in to all conferences to make sure you get credit for attendance. QR codes are posted on the wall near both doors.

• Be an active listener and participant--these conferences are meant for your benefit.

• Nurses and staff are instructed not to page or EPIC chat during conference time to preserve your educational experience.  

 

Other Meetings

Once a month, the program will have a housestaff meeting at UCLA in lieu of noon conference, when you'll get the chance to talk to the program leadership about upcoming program issues.  This will also be a chance for you to voice any concerns you might have directly to the head honchos!  

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UCLA Support services

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Ancillary Services List: Great Reference for Seniors! (click here)

Each of your patients will have a team of doctors taking care of them...but you will also rely on teams of nurses, social workers, and child life specialists (to name a few) to help provide the best care for our children. Below is a contact list to help you locate all the people who might be a part of your patient's healthcare team.

 

Nursing
Clinical Coordinators:                   Chai-Chih Huang (pager 93437)  or  Samantha Drohan Betti (x 79581)

Administrative Coordinator:        Clarice Marsh (x 77590, pager 91857)

 

Helpful Pediatric Nursing Numbers:​

• 3rd Flr Nursing Station                     77320

• 5W Nursing Station:                         77530

• Santa Monica Main Peds Floor:      94835

• ER Charge Nurse:                            78444

• Charge RN:                                       73080

 

Pediatric PICC Service

Pager: 93767 / 97342

 

Indication for Referral, to be considered at time of admission:​

• Lack of peripheral venous access

• Multiple days of lab draws

• Any patient requiring > 5 days of IV therapy including:

  • Pre/Post surgical maintenance fluids

  • IV analgesia (for ex: PCA)

  • Hyperosmolar solutions (TPN and Lipids)

  • Irritant drugs (IV antibiotic therapy)​

 

In general:

• If greater than 5 days of IV therapy is anticipated, a PICC line is recommended

• DO NOT consider a PICC line after all suitable IV sites have been exhausted!Save the antecubital veins! Use alternate sites for blood draws and IV starts and write an order to that effect (ie., "no

• blood draws from antecubital veins”)

• Pre-existing PIVs can NOT be used to start PICC lines.

• If the patient is a difficult start, page at 93967;  if available will assess the patient and start an IV (or do the blood draw) to save the antecubital veins.

 

Referral procedure for Doctors ​

• If it is a same day request, please page the PICC nurse at 93767/97342

• PICC nurse will assess your patient to determine PICC candidacy and evaluate need for sedation/analgesia with or without anesthesia involvement.

• All patients <10 years or with high anxiety will need sedation.

• Patients> 10 years may need one dose of anxiolysis, but can usually be done without anesthesia.​

• WRITE  THIS ORDER: "no blood draws or IV starts to antecubital fossa”

• WRITE  THIS ORDER: "EMLA cream applied to antecubital fossa 1 hour before procedure”​

• Then, if anesthesia will be required: Write an NPO order (remember, however, that PICC lines are not placed before 1000, so don't make your patients too miserable). Walk the anesthesia request down to the anesthesia office (anesthesia scheduling - Ray Billones Fax x73612.)

• Then, after the procedure: Order a Chest XRA to confirm placement, specify MIDLINE or PICC LINE on the request (if the PICC nurse hasn't done so already)

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Lactation

• Contact: Lactation consultant Christy Whiteside, IBCLC RLC

• Suite 5215D (across the hall from our peds chiefs)

• Phone  310.267.9517    PGR   800.233.7231    Email   CWhiteside@mednet.ucla.edu

 

Physical Medicine & Rehab consult

• Specify pediatrics and Dr. Nitin Bajaj

• nbajaj@mednet.ucla.edu

• 805-231-6190

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Clinical Social Work (Department of Care Coordination)

• Social Workers are assigned to specific units/services.  Please refer to Pediatric Staff Contact List for social workers' contact numbers.

• There is an on-call social worker after 5pm and on weekends for any social work emergencies. 

• Messages can be left at x79700

 

Appropriate Social Work Referrals:

• Difficulty coping with illness/diagnosis (family, siblings, patient)

• Hospice Education/Referral

• Death/Dying/Bereavement for Family

• Abuse Investigation (Child, Elder, Domestic Violence)

• Problems with medication or treatment compliance/follow-up

• Family or patient behavior problems in hospital

• Resources (support groups, food, housing, community agencies)

• Substance abuse

• Management of psychiatric symptoms

• Education about insurance or county/state financial aid

• Complex/Problematic Discharge Plan (home situation)

• Difficulty negotiating needs of patient to medical team or other hospital services/staff

 

Please remember that resources are limited - please consult a social worker before offering any assistance with meals, parking, lodging or transportation (ie., taxi). 

 

The UCLA Hospital School Program

Contacts: Paula Pleasants, Hospital Teacher (310) 267-9426

 

Description of program:

The main purpose of the hospital school is to maintain continuity of the child's instructional program while he or she is missing school.  The hospital teacher provides instruction in subjects correlated with the child's regular home school. The teacher contacts the home school, request records, standardized test scores, and details of any special education services provided.  Each child is assessed initially to determine current levels of performance and areas of weakness. An individual lesson plan is written to address the academic areas of language and math following the curriculum of the L.A. Unified School District and the education standards established by the state of California.

 

Eligibility:

• Age 5 to 18

• anticipated hospital stay of at least 10 days, from the date the medical referral form is signed

• clinically well enough to receive school instruction

 

Referral procedure for Doctors:

• Complete lower portion of school referral form. These are kept in school file at 3E nursing station.  Must state 10 days or more for length of hospital stay.

• Notify clerk to phone teacher at X79426

• Place signed referral in patient's chart under Doctor's Orders.

 

Performance Improvement/Risk Management

Coordinator:     Nancy Freeman

 

Mission: To provide the highest quality of care for our patients. As a part of the Medical Center/Medical Staff Performance Improvement Program, the Department of Pediatric Performance Improvement develops and implements activities designed to monitor and improve hospital performance.  If you have any concern about quality of care, ie., a med error or something, please talk to Nancy. It is not "tattling,” it is helping us all learn and design better systems for safe practices.

 

Organization:   

Under the direction of Sherin Devaskar, MD, Rick Harrison, MD, is assigned to implement, coordinate and report on the Department activities. 

Responsibilities include:

• Present cases, with educational value and practice issues/information, to the faculty and housestaff at the monthly Performance Improvement Conference.

• Initiate actions necessary to resolve identified problems, i.e., education review, training, and counseling.

• Evaluate results of actions for improvement/change through monitors and/or audits.  Report quarterly to Performance Improvement Committee.

 

Specific Performance Improvement Indicators (ie, things that this department should know about):

​Quality

• Medication errors.

• Code Blue Review and Evaluation

• Cases coded for Potential Complications

• Readmission to the same service within 5 days, post discharge.

• Readmission to a different service within 5 days post discharge

• Readmission to PICU within 48 hours

• Deaths

• Trauma

• Cardiac catheterization complications

• Referrals

• Invasive Procedure complications (3E Procedure Rm.)

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Service

• Patient and Family Satisfaction Survey

• Special Projects

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Peer Review Techniques in which you'll be participating:

• ​Morbidity and Mortality (M&M) Review is conducted monthly by faculty representing the divisions of Pediatrics.  The Committee is closed and is chaired by Rick Harrison, MD.

  • Individual cases of missed diagnoses, delay in care, treatment failure or complication, etc. are presented within sixty days of referral to the M&M Committee.  Each case is assessed according to established community practice standards. 

  • The physician or other medical caregiver is notified within a reasonable time of the Committee decision and of the coding value applied to the case.  The physician is given an opportunity to support his/her actions and decisions.  Corrective action that requires re-training must be completed within sixty days.   The Committee may re-code the case after further discussion and consideration.

  • Approximately one week following the M&M Committee meeting, in lieu of Noon Conference, cases with instructional or educational value are discussed at the Performance Improvement Conference before faculty, housestaff and representatives of nursing, pharmacy, and social work.  This multidisciplinary discussion is done with the knowledge of and/or participation of the responsible physician.   

  • Referred cases from other departments, housestaff, medical staff, and nursing are discussed.

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Child Psych inpatient consultation at RRMC

• Obtain permission from the child’s attending physician on the case for this admission. The attending physician must authorize/order consults for medical-legal purposes.

• Discuss the consultation request with the child and family so they are not surprised.

• Call the page operator and request the child psychiatry consultant on call for Pediatrics or page Peds CL Consult Beeper 97801

• Provide the consultant on call for the day with the following information:       

Patient:   name, diagnoses, room number, age, reason for admission, referral question, estimated length of stay, medical record number

Attending MD: name, beeper number, and indication that permission was granted

Referring MD: name, beeper number

 

What is the Child Psychiatry Consultation-Liaison (CL) Service?

The Child Psychiatry CL consultants conduct psychiatric evaluations of registered inpatients under 18 years of age.  The purpose of an evaluation is to answer a specific question posed by the attending team related to the emotional, cognitive and/or behavioral functioning of the patient.  Once we have conducted an evaluation, we typically continue to follow the case as indicated during the admission.  We also provide in- house treatment interventions (such as focused cognitive therapy, relaxation training, behavioral plans, etc).

We are legally prohibited from specifically evaluating or treating those individuals who are not registered patients, including family of patients or staff members.

The Child CL consultants are on call from 8am-5pm during each weekday, excepting holidays.  An adult psychiatry resident and a child psychiatry attending are on call for acute emergencies during other times.  

 

Who is on the Child Psychiatry CL Service?

Rotating every four months, there are usually two Child Psychiatry and two Child Psychology residents on our service.  They each have about five hours per week available for new patient consultations.  This limitation in coverage sometimes requires us to prioritize requests.

 

Child Psychiatry CL Attendings

     Brenda Bursch, Ph.D.  p95802   &   Marcy Forgey, M.D.    p25449

 

How soon will a patient be seen

Urgent - If the patient is agitated or in other acute distress, please inform the consultant.  Efforts will be made to see the patient as soon as possible. You may be advised to call security or to obtain a sitter in the meantime. 

Routine - We attempt to conduct 95% of our consult requests within 24 hours.  It is not always possible for us to see a patient that is to be discharged on the day that a consult is requested.

 

How do we get an inpatient “transferred” to NPH?

1.      Request child CL to conduct an evaluation and indicate that part of your question is suitability for admission to NPH and/or to another inpatient psychiatry unit.  This should be done as soon as possible after the idea of a transfer is considered in order to allow the maximum amount of time for evaluation and planning. 

2.      Once the evaluation is complete, the child CL consultant will discuss with you the factors related to the feasibility and/or indications for an admission to an inpatient psychiatric setting.

3.      If a psychiatric admission appears indicated, a number of factors need to be investigated:  (a) acute dangerousness requiring a hospital hold, (b) willingness of the patient and family for a voluntary admission, (c) the availability of a psychiatric bed, (d) insurance status and admission requirements, (e) ability of the psychiatry attending and nursing staff to accept the patient given the clinical requirements of the patient.

4.      If the necessary requirements are met and a psychiatry admission is planned, the NPH admitting team will require a detailed discharge note, including medications and other medical interventions that need to be written into the admitting orders.

 

How do we get a pediatric outpatient evaluated?

• Outpatients who intend to harm themselves or someone else, must be immediately evaluated in the emergency room or by an emergency response team (such as a PET team).  Note that some patients might say they want to give up or to die.  In this case, it is important to ask if he or she has a plan to harm him or herself.  Many will say that they would never do anything to harm themselves, they simply feel the desire to escape sometimes.  This does not need an emergency evaluation, however should be followed up by a mental health professional.

• For standard outpatient psychiatric evaluations, call ACCESS x59989. The staff in Access can set up an appointment at one of the child outpatient clinics held in 300 Medical Plaza. Please mention that the patient is a UCLA patient from Pediatrics, as this gives them priority for appointments.

 

How do we get the family members of a patient evaluated?

• Individuals who intend to harm themselves or someone else, must be immediately evaluated in the emergency room.

• For standard outpatient psychiatric evaluations, call ACCESS x59989. The staff in Access can set up an appointment at one of the outpatient clinics held in 300 Medical Plaza.

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Child Life/Child Development Services

Mission: The Child Life Program is a program designed to help hospitalized children and youth with the psychological and emotional aspects of their health care and hospitalization.  The staff is comprised of professionals trained in the field of child development with an emphasis on hospitalized children and families.

 

Staff Availability:   Monday through Friday 8 a.m. to 6 p.m.

                               Saturday and Sunday 9 a.m. to 5 p.m.

                               Ext. 79440

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Appropriate Child Life Referrals:​

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• To assist with effective coping skills

• Preparation for Invasive Procedures or Surgeries

• Life Changing Illness Diagnosis

• Traumatic Injury

• Child Development Concerns

• Little or No Caregiver/Parent Involvement

• Non-Pharmacological Pain Management

• Compliance Issues

• Palliative and End of Life Care for Patients and Siblings

• Sibling Education and Support

• School Concerns or Assistance with School Re-entrys​

• Examples

  • I want my patient to know about their procedure - Call a Child Life Specialist for Therapeutic Medical Play and Intervention...

  • I want to offer my patient a chance to "learn coping strategies” for use during painful or intrusive treatment...

  • My patient will have surgery and needs information that is simple and easy to understand - Call Child Life to help with developmentally appropriate preparation...

  • My patient has siblings that need assistance in understanding their brothers' or sisters' illness or injury....

  • I want this patient's parent or caregiver to have additional information about the impact of the illness or injury on their child's development...

  • My patient needs assistance dealing with stress or anxiety regarding their medical experience.

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CHILD ABUSE/SCAN TEAM & CALIFORNIA LAWS

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IMPORTANT NUMBERS:

SCAN pager p96672

• NOTE: the pager goes to SOCIAL WORK. If also have medical question- please also ask them to involve Dr. Claudia Wang

DCFS Hotline of LAC:1-800-540-4000

                       

DOCUMENTATION:

• When filing DCFS report, MUST DOCUMENT- 16 digit case number, name of worker who takes the call, date/time of phone call

• For cases where concerned for abuse/high risk, use patient’s own words as much as possible (quotation marks). See below for examples: