Harbor-UCLA Emergency Department Newsletter
Your monthly update on clinical excellence, operational updates, and team achievements
October 1, 2025
🎉 Celebrate Today
National Latino Physicians Day
Join us in celebrating the incredible contributions of our Latino physicians who serve our community with dedication and excellence. Today we honor their commitment to healthcare and the unique perspectives they bring to our emergency department.
📍 4–7pm | Assembly Room
Light refreshments will be provided. Come celebrate with colleagues and recognize the valuable diversity that strengthens our medical team.
TL;DR – Quick Hits
Your rapid-fire update on the most critical information you need to know this month
Clozex Available
New wound closure option now available when sedation might be needed (*review the youtube video for a how to use refresher)
-located in the special orders cart and the doc boxes
Specialty Referral Rules
DHS patients: call first | OOP urgent: less than 12 days only
Patient Rights Cards
Red "Know Your Rights" cards are in the doc boxes in multiple languages
AOD Reminders
Please only call the AOD for emergent issues (especially overnight). TEAMS chat is a great option.
No need to call the AOD for Placement Patient outside of the pathway hours (7a-4p). Overnight: send a TEAMS chat and the AOD will review in the AM.
ED Extension Policy
OMFS, ENT, Ophthalmology, Gynecology: same/next-day appointments only
FAST Exam Requirements
Always save images ("End Study") and document findings for trauma accreditation
ED Operations
Critical operational updates that directly impact patient care and workflow efficiency in our emergency department.
1
Clozex Implementation
Our new wound closure option provides an excellent alternative in certain scenarios. Please only use this device when you feel like this may help avoid procedural sedation. This is particularly beneficial for pediatric patients, elderly patients, or those who may be volatile or uncooperative with traditional closure methods.
2
Specialty Referral Guidelines
DHS patients: Please review the guidelines of when we can and cannot book patients into DHS specialty clinics. Most of the time, we need to call their service before booking. Harbor:Main - WikEM  ED to Specialty Clinical Referral Guidance (FINAL).docx
Out-of-plan urgent referrals: Use the urgent follow-up protocol only for appointments needed within 12 days (*see wikiem and Dr. Parmar's previous emails)
Non-urgent cases: Direct OOP patients to their primary care provider or if DHS eligible — can send to CCC clinic ("Har-CCC")
3
AOD On-Call Etiquette
Shoutout to our AODs who take call every day and night (without extra pay).
Reminders:
Overnight: Please only for call the AOD for truly urgent or emergent clinical issues. First troubleshoot with charge nurses and colleagues. Use Teams messages or QR forms for informational updates. No need to wake the AOD for routine placement pathway issues.
Shift coverage: If the next attending does not show up, please call them and if no answers, initiate the back-up protocol (can message AOD on TEAMS as an FYA).
4
ED Extension Services
ED extension is only to be used for patients who need to visit a specialty clinic because that specialist needs specific equipment that can't be brought to the ED. Those visits can only happen same day or next day. In addition, ED extension is only available for the following specialties:
  • OMFS
  • ENT
  • Opthalmology
  • Gynecology
If you put in an ED extension visit for any other specialty (urology, cardiology etc.), or for a Monday when the patient comes to the ED on a Friday (e.g., not the next day), the ED extension will be cancelled, and the ordering provider will be notified.
What to do if your patient needs a next day visit and is OOP? Try the following:
  1. As the specialty service to submit a request for a medical override, they need to contact Dr. Carmen Mendez to do so and should have a discussion with their attending before writing that email. These can be processed next business day.
  1. Admit the patient for re-evaluation in the AM to the specialty service.
Whenever possible, do not ask the patient to return to the ED for a recheck the next day—we want to avoid this.

More to come, Drs. Roh and Parmar will work with hospital administration to sort out a workflow to ensure our patients continue to get excellent care. Please direct any questions or concerns to Drs. Roh and Parmar.
WikiEM Updates & FAST & Lab
WikiEM Clinical Updates
Important protocol updates now live on WikiEM:
Distal Radius Fractures: The emergency department may perform reductions, but orthopedic surgery must review all post-reduction X-rays before patient discharge. This ensures optimal outcomes and prevents complications.
*email Brad or Jen for any wikiem update suggestions
FAST Exam Requirements
Critical for trauma accreditation and proper billing documentation:
  • Always call out: "FAST done [positive (location), indeterminate or negative ] and SAVED"
  • Press "End Study" to Save all ultrasound images to the system
  • Document findings in patient chart
  • If FAST not performed, document clinical reasoning
These requirements are essential for maintaining our trauma center accreditation and ensuring appropriate reimbursement for services provided.
Lab Updates
The lab changed their chemistry analyzer (brand: Roche), they also changed how the anion gap was calculated. The a gap range is now 10-20 and includes potassium in the calculation.
Do you work in Triage?
This is for you
In efforts to send more eligible patients to Urgent Care, please try the following script for low acuity patients you have MSE’d:
“You are eligible to be seen in our Urgent Care. At Urgent Care, you’ll be seen by the same level of medical provider you would see in the Emergency Department. For many conditions like yours, Urgent Care is able to provide the same high-quality care as the ED. Patients in Urgent Care are usually seen more quickly and in a private exam room, which we cannot always guarantee in the Emergency Department. Registration will talk to you about when appointments are available today.”
Joint Commission Readiness
Our survey window is open NOW through Spring 2026. The Joint Commission can arrive any day without notice, so consistent adherence to protocols is essential.
Sedation Documentation
Complete both pre-procedural and post-procedural sedation forms for every case. Include ASA classification and Mallampati scoring. This documentation is frequently reviewed during surveys.
Hand Hygiene Excellence
Wash in, wash out, every single time. Hand hygiene compliance is one of the most closely monitored metrics. Surveyors will be watching our practices throughout their visit.
Available Resources
Review Joint Commission Pearls on WikiEM for quick reference. The complete TJC Handbook is available for comprehensive preparation and ongoing compliance guidance.

Remember: Joint Commission surveyors evaluate not just our policies, but our actual daily practices. Consistency in following protocols is key to a successful survey.
Sedation Documentation
Remember to complete both the Pre-Sedation and Post-Sedation sections of the Procedural Sedation Powerform, especially the ASA Class and Mallampati scores. Missing documentation here from another department was cited at the last survey.
*always wash your hands before and after you see a patient (we are honestly very lucky to have so many alcohol pump stations)
JC Resources
Here are some Joint Commission Pearls on WikiEM: Harbor Main https://wikem.org/wiki/Joint_Commission_(JC)_Readiness

The hospital made an entire Joint Commission Handbook for every one of us. Here’s the digital link for your reading pleasure: TJC Booklet for QR code_9.23.25

The hospital made an entire Joint Commission Handbook for every one of us. Here’s the digital link for your reading pleasure: TJC Booklet for QR code_9.23.25

Quality Improvement & Clinical Updates
Trauma Consultation Protocol
Please make sure to page of “TC” even if you have already seen trauma and let them know (or called). Also, remember to upgrade based on levels outlined on badge tag (eg, if you are upgrading for respiratory compromise, it will be a TTA-1 per our policy)
Ebola Preparedness Alert
  • Incubation period: 2-21 days after exposure
  • Transmission: Body fluids contact, not airborne
  • Early symptoms: Fever, body aches, fatigue
  • Late symptoms: Gastrointestinal bleeding
  • Protocol: Isolate patient and test ≥72 hours after symptom onset
Sepsis Excellence Recognition
Outstanding achievement: 67% sepsis compliance average this year—a remarkable >76% increase from 2023!
Huge thanks to our dedicated ED Sepsis Committee members.
Special congratulations to our R3 residents who dominated the Sepsis Games competition! 🎉
There have now been deaths in LAC linked to 7-OH (discussed in prior newsletter). Please be on the lookout
There is also an Ebola warning for DRC with no reported cases seen in the US. Please be attentive to travel hx. Of note:
  1. The incubation period for Ebola ranges from 2 to 21 days after exposure. Patient are contagious after symptoms appear.
  1. Ebola disease is spread through contact (through broken skin or mucous membranes) with the body fluids (e.g., blood, urine, feces, saliva, semen, or other secretions) not airborne transmission.
  1. An Ebola vaccine (ERVEBO®) is FDA approved and two FDA-approved treatments are currently available to treat Ebola virus infection: Inmazeb™ and Ebanga™.
  1. Early "dry" symptoms include fever, aches, pains, and fatigue and later "wet" symptoms include diarrhea, vomiting, and unexplained bleeding.
  1. Include Ebola in the differential diagnosis for patients with sx AND 1+ risk factors within the 21 days before symptom onset:
  • Direct contact with a symptomatic person with suspected or confirmed Ebola (alive or dead), or with any objects contaminated by their body fluids.
  • Breach in infection prevention and control precautions that resulted in the potential for contact with body fluids of a patient with suspected or confirmed Ebola.
  • Participated in any of the following activities while in an area with an active Ebola outbreak:
  • Contact with someone who was sick or died, or with any objects contaminated by their body fluids.
  • Attended or participated in funeral rituals, including preparing bodies for funeral or burial.
  • Visited or worked in a healthcare facility or laboratory.
  • Contact with cave-dwelling bats or non-human primates.
  • Worked or spent time in a mine or cave.
  1. Consider common diagnoses (eg, malaria, UTI, etc.)
  1. Immediately isolate and hospitalize at risk patients until receiving a negative Ebola test result on a specimen collected ≥72 hours after symptom onset.
Please contact Dr. Claudius, EM QI Director, if you have cases related to quality and patient safety.
EMS & Disaster Preparedness
EMS Protocol Updates
Critical changes to our emergency medical services coordination that require immediate implementation:
  • STEMI & Trauma Pre-Activations: Don’t forget—please pre-activate all accepted STEMIs and Traumas arriving to Harbor by EMS!
  • Mini Activation Drills: Practice like you play! To train new staff and stress-test our systems, you might get a HERT or Emergency Operations Plan (EOP) mini-drill on day or night shifts. If you’re knee-deep in patient care, just give a quick acknowledgment and get back to business—we get it.
  • Disaster Exercise: Mark your calendars: November 20th is this year’s big disaster exercise. It might just have us ShAKiNG!!
  • Tabletop Session: Want to talk through what an ED evacuation would look like? Join the ED Preparedness Committee’s tabletop exercise on October 13th at 0740 in the ED Ambulance Bay Breakroom. Coffee, scenarios, and just enough chaos to keep it interesting.

ED Evacuation Tabletop Exercise
October 13 @ 7:40 AM
Ambulance Bay Breakroom
Coffee will be provided!
ORCHID System Tips
Essential ORCHID navigation tips to streamline your workflow and ensure proper consultation routing:
Social Work POSC Orders
Use Social Work POSC consultations exclusively for pregnant patients with substance use issues. This ensures appropriate resource allocation and specialized care coordination.
Auto-Paging Consults
Only consultation orders marked "Auto Paging Harbor" will actually send automatic pages to the consulting service. Verify this designation before submitting.
Gynecology Consultations
Use the single "Consult to Gynecology" order for both obstetric and gynecologic consultations.
Remember that only consults listed in the “Auto Paging Harbor” section of the quick order page will send a page. Consults in the “No Auto Paging” section or those found from the search box will not send a page.
Use the “Consult to Gynecology” for both OB and GYN issues.
Department Celebration
🎭 Department Retreat Success!
What an incredible turnout and an absolutely wonderful retreat! Thank you to everyone who attended our department retreat. The energy, enthusiasm, and camaraderie were truly exceptional.
Special recognition goes out for the costume parties—the creativity and commitment were next level! From elaborate class themed outfits to hilarious Y2K Cartoon character portrayals, everyone demonstrated the same dedication and attention to detail that makes our emergency department excellent.
These moments of connection and celebration strengthen our bonds as colleagues and remind us why we love working together to serve our community.
*And BIG Shoutout to all of the attendings who worked in the ED over retreat weekend. Thank you so much!
Key Department Contacts
Your essential contact directory for departmental issues, questions, and support. Save these contacts for quick reference.
AED Issues
Dr. Jen Roh
AED Medical Director
For all adult ED/operations/newsletter questions
Overall Operations Issues
Dr. Brad Chappell
Vice Chair of Operations
OOP Follow-up & ICE
Dr. Parveen Parmar
Executive Vice Chair
Out-of-plan follow-up coordination and ICE-related issues.
Note: On leave Oct 24–Feb 1
Coverage: Dr. Roh / Dr. Chappell
Quality Improvement & Safety
Dr. Claudius
ED QI Director
ORCHID System Support
Dr. Fleischman & Dr. Jenn Fang
Electronic health record issues, system navigation questions, and ORCHID optimization.
EMS & Disaster
Dr. Kelsey Wilhelm
EMS Medical Director
Emergency medical services protocols, pre-hospital care coordination, and EMS-related policies.
Peds ED Issues
Dr. Patricia Padlipsky
PED Medical Director
Looking Forward
1
Oct 1st
Joint Commission Survey window opens (ends in Spring 2026)
National Latino Physicians Day
2
October 13
ED Evacuation Tabletop Exercise at 7:40 AM in the Ambulance Bay Breakroom
3
October 24
Dr. Parmar begins leave through February 1st - coverage transitions to Dr. Roh and Dr. Chappell
4
November 20th
This year’s big disaster exercise
It might just have us ShAKiNG!!
Coming Soon!

Ortho CTs needed for pre-Op for DHS patients will soon be able to be scheduled outpatient (will not need to hold every single Ortho patient in the ED to wait for a CT. Hooray!). Launch Date TBA.
Observation Admit Process — Launch Date and details TBA
Thank you for your continued dedication to excellence in emergency medicine. Together, we provide exceptional care to our Harbor community every single day.
Stay tuned for next month's newsletter featuring more clinical updates, team achievements, and operational improvements that keep our emergency department at the forefront of medical excellence.

Share Your Stories

Contribute to Our Next Issue Your voice matters! We want to hear about your experiences, achievements, and insights that could benefit our entire emergency department team. Share your clinical updates, patient success stories, quality improvement ideas, research findings, or photos from department events. Every contribution helps strengthen our community and keeps everyone informed about the incredible work happening throughout our department. Email Dr. Jen Roh