Harbor-UCLA Emergency Department
December Newsletter 2025
Happy Holidays, Harbor ED! 🎄
  • The holiday season is in full force—and so is our December newsletter
  • Lots of important clinical + non-clinical updates
  • Thank you for your dedication to our patients and each other
  • Wishing you a safe, restful end to 2025—see you in 2026!
— Dr. Jen Roh, AED Medical Director
TL;DR (Quick Hits)
NEW – Effective TODAY (12/17)
COVID testing no longer required for adult or adolescent Psych ED patients unless symptomatic 🎉
Operational Updates
  • RNs may now complete work/excuse notes (≤24 hrs, no restrictions)
  • New UA Reflex to Culture order is LIVE
Clinical Reminders
  • Sepsis: please ensure repeat lactates until cleared
  • Initial ESI assigned at triage should not be changed
Department News
  • NP of the Year nominations 🎉
  • Disaster drill success
  • Please support Ciro's GoFundMe
In This Issue
  • Operations Updates
  • The Clinical Corner
  • Joint Commission Reminders
  • EMS + Disaster
  • Pediatric ED
  • IT / ORCHID
  • Wilderness Medicine
  • Social EM & Wellness
  • Department News
Operations Update
Psych ED COVID Testing
NEW – Starting 12/17
  • COVID testing is NOT mandatory for Psych ED (adult & adolescent) unless symptomatic
  • 🎉 Big workflow win!
If Symptomatic:
  • Adult & pediatric patients in Med ED → test prior to Psych ED transfer (unchanged)
  • Adult patients brought directly to Psych ED by EMS → test in Psych ED (unchanged)
RN-Driven Work / Excuse Notes (NEW)
What's New
  • RNs may independently complete and sign work/excuse notes
  • Applies to discharged ED patients and accompanying visitors
*Shoutout to Dr. Chappell, Nursing leadership and Cesar for making this happen!
RN Work Notes: Details
Patients
  • Up to 24 hours off from discharge date
  • 24 hours or restrictions → provider determines
Family / Visitors
  • Notes for visit date(s) only
Previously Discharged
  • Router RN may complete ≤24 hrs
  • 24 hrs → triage provider signs
NEW UA Reflex to Culture Order (LIVE, finally!)

Order Name
Urinalysis w/ Reflex to Microscopic and Culture, if Indicated
Why This Matters
Improves diagnostic accuracy
Reduces unnecessary cultures
Decreases inappropriate antibiotic use
How the Reflex Order Works
Macroscopic UA (Dipstick)
  • Normal → stops
  • Abnormal → reflex to microscopic
Microscopic UA
  • 10 WBC/HPF → urine culture
  • ≤10 WBC/HPF → no culture
When to Use (and NOT Use)
Use For:
  • Symptomatic UTI workups
  • Immunocompetent patients ≥2 years old
DO NOT Use For:
  • <2 years old
  • Pregnant
  • Immunocompromised
  • Renal transplant
  • Neutropenic / recent chemo
  • Indwelling Foley
CDS: What You'll See when you order
Optional prompts for routine cystitis
Required prompts for:
  • Foley patients
  • Immunocompromised patients
ED Ops Reminders: Important ESI Reminder
  • Per guidelines the initial ESI assigned at triage stands and must not be changed
  • Do NOT change the original ESI even if patient later appears more complex after results or even decompensates
Concerned About a WR Patient?
  • Communicate with RME Charge (x66950)
  • Consider R3 placement if needed
Team Assignments & Load Balancing
Please help keep Green & Purple assignments balanced
Notify Acute/RME Charge or OCN if loads appear very uneven
Teamwork = safer care
Interpreter Use
  • In-person interpreters: x68440 (6a–11p, 7 days/week)
  • Insight app is an alternative—be mindful of cost (*we are charged per minute)
  • Please prioritize in-person interpretation when available
Follow-Up & Tracking Board Updates
1
Yellow star → Green star once specialty follow-up is scheduled
2
PAC staff education underway
3
Expect consistent green stars by end of month

Reminder:
Remove "Lab follow-up – CCC" if no longer needed
WikiEM & Clinical Pathway Updates
Hip Fracture Pathway Clarification
  • Low-energy mechanism applies ONLY to femoral neck fractures
  • All others → Trauma (right of refusal applies)

Low Energy Mechanism (ground level fall) ... only applies to FEMORAL NECK FRACTURES, NOT intertrochanteric, subtrochanteric, mid-shaft/distal femur, or pelvic fractures
  • Age >/=65: Admit to IM/FM with Ortho & Anesthesia consults
  • Courtesy consult to Anesthesia (65942 after 6p) for fascia iliaca block (should not delay admission process)
  • Any ED faculty comfortable placing a fascia iliaca block may perform it PRIOR to Ortho evaluation of the patient
  • <65 without ACTIVE medical issues (medical co-morbidities requiring active management): Admit to Ortho with Anesthesia consult
  • <65 with active complicating medical conditions: Trauma has right of refusal; if cleared by Trauma, admit to IM/FM; Anesthesia consult regardless of admitting service
High energy mechanism or intertrochanteric, subtrochanteric, mid-shaft/distal femur, or pelvic fractures: admit to Trauma with Ortho & Anesthesia consults
Sepsis QI Reminder
Please ensure repeat lactates until <2
*repeat lactates must be done < 6 hours when criteria for severe sepsis/shock met
Use Code Sepsis paper form as reference
Keep using the '.harsepsis' dotphrase (it works)
Huddle early with bedside RN and make the game plan
Updated SEP-1 tips available on WikiEM
ED Pharmacy Updates
Now Available in ED Pyxis
  • Ertapenem 1g IVPB
  • Linezolid 600 mg IVPB

Pearl:
Ertapenem may be appropriate for ESBL pyelo without septic shock
Remember coverage limitations
Review prior Micro's and allergies
Procedures: Lines & Kits
New A-line procedure form
New central line kits rolling out
  • Lidocaine included
  • Pre-capped lines
  • Be mindful of line length
Triage Team Reminders
Alternate unassigned triage rooms when short staffed
Do not leave triage without coverage
Call attending by phone for staffing questions (*do not leave triage)
Communicate clearly with RN team
The Clinical Corner
Marburg Virus Update
With Dr. Ilene Claudius
  • Reports in Ethiopia
  • Viral hemorrhagic fever
  • Transmission: contact (not airborne)
  • Mortality: 23–90%
  • No US cases as of Dec 3
Marburg: Who to Call
LA County DPH – Acute Communicable Disease Control
Weekdays
213-240-7941
After Hours
213-974-1234
(ask for physician on call)
Joint Commission Reminders
Procedural Consents
  • Must document interpreter use in patient's preferred language
  • Written consents available in English & Spanish
Procedural Sedation = 3 Steps
01
Time Out Checklist
02
Pre-Sedation Note
03
Post-Sedation Note
Click on the gallery to see screenshots of the forms
Chaperone Policy
Please review Harbor's Chaperone Policy
Required for all sensitive exams
A junior team member should not chaperone a senior team member (*find a peer, RN or attending)
EMS & Disaster
Disaster Drill Success (11/20)
  • Over 120 ED participants
  • First ED evacuation
  • Multiple care sites
  • MCI integration with EMS Corps
Thank you for outstanding teamwork!
Pediatric ED Updates
Key Reminders
COVID testing no longer needed for asymptomatic adolescent psych
Avoid full respiratory panels unless considering admission (<12 yrs)
Call anytime: 310-930-6387
— Dr. Patricia Padlipsky
IT / ORCHID
System Updates
Yellow → green star functionality now live
Registration will be changing the yellow star to a green star when the specialty follow-up appointment has been made.
Request for Urgent Specialty order: When you place the order, a yellow star will appear on the tracking board. After much IT effort, the functionality is there so the star will turn green when the appointment has been made; PAC staff is being educated, so expect to see this consistently by the end of the month.
Contact Dr. Fleischman with questions
Wilderness Medicine
Upcoming Events
WMS Winter Conference
Feb 22–25, Lake Tahoe
DEM Catalina Trip
April 24–26
  • Hyperbaric chamber
  • Baywatch ride-alongs
  • Skills training
The Wilderness Medical Society winter conference will be February 22-25 in Lake Tahoe. Contact Ross Fleischman for more information. Link: 26 Winter Conference WMS
The DEM Wilderness Medicine trip to Catalina will be April 24-26th. We will visit the hyperbaric chamber, ride with the Baywatch paramedics, and practice wilderness medicine skills. We expect to host some UCLA medical students. Contact Luke Yeager for more information.
Social EM
Cell Phones for Patients
Cell phones are still available for patients with substance use disorders
Contact Social Work or Raul Garcia
Wellness Updates
Rounding Room Glow-Up! ✨
  • We have a new bookshelf (shoutout to the Wellness committee for buying/and R3 ladies for building this!) and a new storage shelf (a holiday gift from Dr. Jen Roh)
  • Thank you Wellness Committee & R3 team and Dr. Roh!
Please help keep the room clean and organized
Department News
Celebrations
Harbor NP of the Year Nominees 🎉
Florence Fernandez
Erwin Yson
Thank you for your leadership, dedication, and positivity!
Resident Shoutouts ❤️
Submitted by: Cesar Fortuna
Shout out for: V Nainesh Shah
Shout out content: As we left a busy Green Day shift, a patient’s family member stopped him in the hall to thank him for being so kind and nice. Sometimes shifts get busy, tough, and exhausting and you get lost in the thick of it, but kindness to your patients and their families, is something they’ll always remember
Submitted by: Cesar and Aislinn
Shout out for: Holly Mulinder
Shout out content: When Dr. Mulinder’s pt wanted to elope, she offered them a sandwich and even warmed it up in the microwave to convince the pt to stay
Submitted by: Cynthia
Shout out for: Arjan Abar
Shout out content: Shoutout to Arjan for being on a quiet Peds night and surprise-helping our busier green night team with an I&D and lac repair!!!! 12/10 dispo king and friend. 🫶🫶
Shout out for: Karla
Shout out content: Karla is a rockstar for seeing the whole board while I was stuck resuscitating a few sick patients. Couldn’t have gotten through that shift without such an excellent teammate!!
Thank you for living our Harbor values
Supporting Our Colleague
Help Ciro Fight Stage 4 Lymphoma
  • Ciro Murgueitio has been a beacon of hope for so many in the Harbor-UCLA Emergency Department, always ready to lend a hand and a smile during the toughest moments. Now, he faces his own battle against Stage 4 Lymphoma, a fight that no one should have to endure alone. This diagnosis has not only put his health at risk but also threatens the financial stability of his family. Raising funds will cover the initial treatments at City of Hope, allowing Ciro to focus on recovery without the added stress of medical bills. Every contribution, no matter the size, can make a real difference in his journey. Please consider donating or sharing this message to help give Ciro the chance he deserves to heal. Thank you for your support during this challenging time.
Donate to his GoFundMe here: https://gofund.me/bd3c5710a
Thank You
Thank you for everything you do—for our patients, our learners, and each other.
Have a wonderful Holiday Season and fantastic end of 2025 🎊
If you have updates or stories for future newsletters, please email: [email protected]
— Jen Roh