Purple Book

Day Call (on pager 8AM – 4:30 PM):

  • Begins at 8AM. At approximately 5AM an email is sent out by the on-call resident with the status of the ER. Scroll through this email when you get up to see if there are any child boarders still waiting for a bed at UCLA or a community hospital.
  • If there is a boarder, but NPH or an outside hospital has accepted them, nothing to do
  • All other boarders will need to be seen in the morning and staffed with attending for disposition. Fellows coordinate with each other on splitting boarders between them if there are multiple.
  • Alternate covering the Child Psychiatry Consult pager (p97801) with your co-fellow. Decide amongst yourselves how to split up coverage, traditionally, fellows alternate pager coverage every two weeks, but will alternate seeing each consult that comes in.
  • For all new ED consults during the day, you will be paged by one of the ER psychiatry SW (x79071), who accepts incoming consults for both adult and child psychiatry. If the ER pages you directly, refer them to the ER psychiatry SW at p95722. If an outside hospital pages you for a transfer, refer them to Admissions at x78009. We do not coordinate transfers.
  • Before going to see an ER patient, text the attending and co-fellow to let them know you received a consult and forward the page to the team from your email. The attending will coordinate to either meet you in person or staff over the phone / Zoom, depending on their availability at that time.
  • You will see patients and their families in their assigned room or hallway bed. Do not hesitate to ask the ED staff for a patient to be moved if you see that they need a safer environment. It can be challenging to use the current ER space.
  • After assessing the patient, check in with the attending to discuss the dispo plan. Update the ED SWs ASAP about dispo plan, whether it is DC or admission.
  • If admitting the patient, SW will tell you if there is an NPH bed, or if patient will have to be transferred to an OSH. If NPH bed available, they will contact finance/admissions offices and will give you the 4W bed number when available.
  • Please file JV220 for patients under DCFS.
  • Upon receiving the bed number, placed Discharge-Readmit orders, call 4W to give admitting nurse report, complete consent for hospitalization and medications. Continue to monitor/manage patient until admission happens.
  • If the patient is being discharged, you will safety plan with the family and sign out their status to SW.
  • Whether dispo is DC or admit, follow up with the ER resident to update them on plan
  • The cut-off for the last ER consult for day shift is 4:00PM. Between 4:00 and 5PM, ER psychiatry SW holds and signs out incoming consults to the evening shift.
  • At 5PM, SW sends an email with signout from the day team. If you are still seeing a consult at that time, you will need to respond to their email and include sign out for your final case(s).
  • If multiple consults come in during the period of 3 – 4PM, SW will assist in determining which consults to hold over to the incoming moonlighter or the incoming child fellow, and which will be seen by the day fellow. Rule of thumb is that a fellow can accept 2 cases at a time but not more, because two can theoretically be seen within a 90 minute timeframe, without documentation. If it will take a fellow more than 90 minutes to get to a consult, it is generally bumped to the evening fellow or moonlighter.
  • In case a patient does come in at 3 – 4 PM and you would like to get started before being paged, you may contact SW to let them know you will see the patient and to update you once they have received the page.