Harbor-UCLA ED Newsletter
February 2026
A packed month to celebrate: Women Physician's Day, Black History Month, and continued operational evolution in our department.
Operations
Operations Update: Flow, Throughput & Surge
Round 2 Live 2/9
What Changed
"Round 2" of our throughput workflow officially started February 9.
To help get orders done when seeing Fast Track/Surge patients without an assigned nurse (can also do this if on a team and have capacity to see more patients)
The Process
  1. Place all necessary orders (labs, EKGs, meds, imaging, registration, DC orders).
  1. Complete the simple task form.
  1. Place it in the bin between the Flow RN and RME Charge RN.
Why This Matters
This prevents delays when patients are physically roomed but not yet fully staffed. It allows nursing to prioritize tasks efficiently and reduces bottlenecks.

Critical Escalation
If you identify a patient who appears clinically unstable and needs a bed immediately:
  • Verbally notify RME Charge immediately.
  • Do not rely on passive documentation.
OOP Orthopedic Follow-Ups
For Out-of-Plan (OOP) orthopedic follow-up patients:
  • Triage and FT providers should identify these patients early. Triage providers please put "here for Ortho referral"
  • The first available provider should arrange "urgent OOP follow-up" as soon as possible.
Why This Matters
Early identification reduces how long the patient has to wait until told "unfortunately you cannot follow-up with Harbor Ortho" and can get them connected to their health plan sooner. This process has improved, but continued vigilance is needed.
Primary Stroke Center: Go Live March 2
Harbor is going live as a Primary Stroke Center on ReddiNet March 2nd
New Workflow
1
EMS prehospital stroke notification.
2
ED + Neuro team meet patient at the back door (similar to trauma).
3
Quick joint evaluation.
4
Direct-to-CT workflow (CT1 preferred).
5
EMS gurney → CT scanner without delay.
Nursing will:
  • Bring transport monitor.
  • Bring destination bed post-CT.
Pharmacy Coordination
If TNK is being considered:
  • Communicate early with Pharmacy.
  • This reduces door-to-needle delays.
Why This Matters: This change directly impacts stroke metrics and functional outcomes.
Autopaging Reminders
OBGYN Paging
  • Use Consult Gynecology autopage only.
  • The Obstetrics autopage is not connected and will not reach anyone.
PERT Team
  • Cerner autopage should be working now
Backup Process
  • Use Harbor Intranet or Spok (310-501-9956).
  • If no response → page Pulmonary Attending.
  • Contact Dr. Alex Grohmann or Dr. Janine Vintch with concerns.
ED → Rancho Los Amigos (RLA) Direct Admissions
We routinely have ~20 ED boarders while RLA has ~40 open beds.
Transfer Criteria
  • Monday–Friday, 8am–10pm only.
  • No ICU or unstable patients.
  • DHS empaneled or eligible patients only.
Process Overview
  1. Place "Consult to Transfer Center."
  1. Ensure patient is willing to transfer (*tell them Rancho is nice)
  1. RLA hospitalist calls back within 15 minutes.
  1. Sign EMTALA.
  1. Arrange BLS/ALS transport.
If declined:
  • Admit to Harbor per usual process.
5
Bed-Days Saved
Each direct admission to RLA saves ~5 inpatient bed-days at Harbor. This is one of our most powerful boarding reduction tools.
Escalation: Contact Dr. Chappell in real time if issues arise.
IT / ORCHID Updates
.edExposure Dotphrase
Use for all needlestick injuries. Includes full documentation template and follow-up instructions.
RME + Triage Filter Expanded
Now includes rooms A37–42. Allows single-screen view of:
  • Waiting room
  • Triage
  • Tasking
  • All FT rooms
Helpful for Surge Team situational awareness.
Spanish EMTALA Consent
Coming soon.
Safety & Regulatory Reminders
Limit verbal orders to true emergencies.
Sign orders promptly.
Order Ambulation Trials for:
  • All high-risk discharges
  • Consider routinely for patients ≥65 years old.
Triage Reminders
ED to UCC
Send eligible DHS patients directly to UCC when appropriate. Goal: Fill ~15 UCC appointments daily. This reduces ED length of stay and waiting room congestion.
  • Do NOT routinely order nebs from triage (unless sick — communicate with RME charge)
  • Avoid IV meds (think of PO and IM alternatives)
  • No IV opioids in RME tasking (PO and IM ok)
  • No lumbar x-rays for atraumatic low back pain.
Billing
Billing & Documentation: Why It Matters
This new section highlights professional development and departmental sustainability.
Accurate documentation:
Reflects case complexity.
Improves reimbursement.
Supports patient safety.
Protects legally.
Diagnosis Documentation
List all relevant diagnoses (And list the most critical diagnosis first!). Example:
  • Hypoxic respiratory failure
  • Severe sepsis
  • Pneumonia
  • Lactic acidosis
  • Hyponatremia
  • AKI
EKG Documentation
Include ≥3 elements:
  • Axis
  • Rhythm
  • Rate
  • Intervals
  • ST/T changes
  • Comparison to prior
Shoutout to Manny for contributions.
Clinical
Clinical Corner: Hip Fracture Admissions

Key clarification: Low-energy mechanism rules apply only to femoral neck fractures, NOT intertrochanteric fractures.
Age ≥65:
  • Admit IM/FM
  • Ortho + Anesthesia consult
  • Fascia iliaca block encouraged
High-energy or intertrochanteric fractures:
  • Admit to Trauma
Admission Rules
Why This Matters: Several hip fractures were missed. Misclassification can delay care and alter outcomes.
Geriatric Pearls
Always document hip exams in elderly.
Knee pain may be referred from hip.
If ambulation abnormal → consider advanced imaging.
Order Ambulation Trials routinely in elderly.
Opioid Caution
Fentanyl half-life may be 10x longer in elderly.
Reduce dose ~25-50% when appropriate.
Avoid stacking.
Alert
Toxicology Alert: Medetomidine
Emerging fentanyl adulterant. Alpha-2 agonist (100–200x potency).
Clinical Effects
Sedation
Bradycardia
Hypotension
Naloxone does not reverse non-opioid effects
Withdrawal Syndrome
  • Tachycardia
  • HTN
  • Tremor
  • Diaphoresis
  • May require intubation

Treatment:
  • Supportive care
  • Clonidine patch preferred
  • Dexmedetomidine class agents
Report cases to Poison Control.
Infectious Disease
Infectious Disease Updates
Measles
3 LA County cases (travel-related). Remain vigilant in febrile rash illnesses. Call the LA Public Health Department early. They can guide you regarding possible cases and they will also follow-up with the patient. We have a firstnet orderset for Measles testing.
Screwworm (Not in U.S. yet)
Think:
  • Non-healing wounds
  • Sensation of movement
  • Larval infestation
Rare but high-consequence diagnosis.
Helpful Flu Chart
*encourage patients to get their flu shot (fyi, UCC can give vaccines such as flu shots)
Joint Commission Reminder
Please complete Compounding Medication Training (TalentWorks).
Deadline: February 18.
*Post-test may be repeated to pass.
DHS: Expected Practices and Key Considerations of Immediate-Use Medication Compounding
*Very important for JC compliance
EMS
EMS & Disaster Updates
1
EMS Day
Mark your calendars: May 14th!
2
Base Physicians
Take ≥2 base calls per month. Maintain radio skills.
3
Community Outreach
Volunteers needed for:
  • Stop the Bleed
  • CPR trainings
  • LAUSD
  • Compton Unified
  • Gardena
Reach out to Dr. Tabitha Cheng.
Also looking for volunteers to teach stop the bleed 2/11 and 2/25 at Compton unified school district (teaching teachers to teach stop the bleed to other teachers, staff, and their students - we donated 2,500 stop the bleed kits last week to their district!). And another few hands only cpr trainer sessions in Compton or Gardena:
  • February 13, 10:00 AM  (Compton unified)
  • February 19, 9:00 am (Compton unified)
  • March 8th at 1:30-3PM (Compton- Spanish language training session - helpful to be bilingual but likely can still help if not)
  • February 11th at 6:30PM (Gardena)
4
HERT Training signups
The annual Hospital Emergency Response Team (HERT) training will take place of Tuesday, April 21 at the Los Angeles County Fire Department training center in Del Valle.
Attendings and base-trained senior residents can participate, practicing realistic confined-space rescue, field amputations, and other urban search and rescue medical procedures. Interns and R2 can attend as observers and assistants.
More information and the required training video here: https://vimeo.com/951194855/895e2f58e2
Pediatric ED Updates
Genetic/Metabolic Letters:
  • Uploaded to General EM Teams folder.
  • Found under Complex Care Plan in charts.
  • Contact Genetics early for these high-risk patients.
These patients may deteriorate rapidly without prompt intervention. Check their letters.
Wellness
Wellness
As you know, to all of our sadness, the Jura Giga 10 had been MAC transferred for higher level of care with an ELTC for further stabilization, with a 100% occlusion in the left main grinder causing a full arrest. He is currently being transferred via UPS, but expected to return soon.
See the heartfelt note to Jura from our interns. Jura was severely missed.
In the interim, we have a Nespresso machine with 180 Nespresso pods, which will eventually be relocated to the new EM resident lounge in the new outpatient tower once the Jura is back.
The new microwave has arrived! (shoutout to Devika and the wellness team for replacing the old rusty one!)
Quiet/Lactation corner is ready! Shoutout to Meg and the Wellness Committee for getting this together!
Please give priority to lactating persons, but otherwise enjoy the space.
Nerve block models are at the top of the white storage shelf
Lots of random stuff in the room. Please take your things from the rounding room or they might be tossed. And please empty the fridge of old food!
Shoutouts
Resident/Fellow Shoutouts
For Bea – very proactive in patient care. Thinks ahead about patient needs and needs of the team. Provides very well-rounded patient-centered care. It is noticed and appreciated
Nursing Shoutouts
Elizabeth Warren, one of our wonderful adult nurses! She noticed an abnormality in a vein while performing an ultrasound guided IV on a patient with a history of breast cancer. Brought it to the attention of the team, and the patient was found to have an upper extremity DVT. Great catch! 😊
"The only thing more powerful than hate is love."
- Benito Antonio Martinez Ocasio
Have a fantastic month
Questions or Submissions for the Newsletter
Dr. Jen Roh