PGH GUIDELINES for REFERRALS

1. NEW: Submit 2 referral sheets and an updated clinical abstract AND special referral form depending on dept/section 2. FOLLOW-UP/INFORMING OF PATIENTS LOCATION: 1 referral sheet only (indicate name resident/fellow who previously saw the patient), no need for abstract 3. Log in respective logbooks. 4. Referrals can be dropped any time of the day unless the respective office is only open during office hours, e.g. OPD. 5. Beyond the cut-off time, referrals will be seen the next day (especially for SAPOD)
Department of Anesthesiology y For preoperative evaluation (usually done by RIC): o Indicate procedure and scheduled date o Tack on the board near anesthesia call room (near LCB OR) y Pain Clinic: Drop at 2nd floor OPD near surgery Department of Family Medicine (Supportive, Palliative, and Hospice Medicine) y Special referral form available at Hospice Office 3rd floor OPD y Include RICs contact number and reason for referral y Drop at Hospice Office 3rd floor OPD Department of Medicine A. GEN MED (for co-mgt) y Drop at 3rd year med residents call room, mezzanine, back of W3 B. SAPOD Referral (for surgical or procedural clearance) y Indicate specific surgical AND anesthetic plans y Make sure all lab results are in before referring y Labs for General Anaesthesia: FBS, Crea, Na, K, Cl, CBC c pc,dc, urinalysis, 12-L ECG (attached to chart), and CXR (plates at bedside) y Labs for Local Anaesthesia: FBS, Crea, Na, K, Cl, 12-L ECG (attached to chart), and CXR (plates at bedside) o Include U/A if patient has DM o Include PT/PTT if anesthesia plan is SAB y If previously cleared in the OPD: photocopy medical clearance form and attach to referral forms; indicate date and name of IM resident y Have a first year IM resident countersign the referral forms before logging y Logbook located on the table outside Rheuma Office at the back of W1 y Cut-off time: 12nn (but can be dropped any time of the day) C. ALLERGY/IMMUNOLOGY y 8am-12nn: Room 2P04 OPD y 12nn-4pm: Allergy lab at ERC y All referrals for ADRs must be reported to ADR Committee (get and submit form from Central Block Pharmacy) D. CVS y Pre-requisites: Gen Med referral, 12-L ECG, CXR plates @ bedside th y Drop at 6 floor outside CVS office E. DERMATOLOGY y 2 Derma forms (available at Derma OPD) + 1 clinical abstract with complete derma PE y Drop at Derma OPD F. ENDOCRINOLOGY y Include necessary labs ( FT4 & TSH for thyroid cases, FBS & HbA1c for DM) y Include CBG monitoring if DM patient y Logbook outside the entrance of MRL, 2/F ERC G. HEMATOLOGY y Logbook outside MRL entrance, 2/F ERC y For anemia, include PBS, CBC, reticulocyte count, TB, IB, U/A with urobilinogen determination, FOBT H. IDS 1. Ward nd y IDS referral form (available in IDS office, 2 floor ER Complex) + clinical abstract

y Fill up the form (include fever pattern, antibiotics, culture studies, etc) y Have the form signed (with trodat) by service senior y Drop at IDS Office, 2nd floor ERC 2. CAAP y Forms available at central block pharmacy y Completed IDS referral form (see above) + CAAP form + clinical abstract y Include at least gram stain of involved organism y Drop at Pharmacy Central Block 3. ICC Antibiotic Surveillance y ICC form available in any ward y Fill up completely with junior and senior residents trodat y Drop at 2nd floor ERC drop box y Cut-off: 3pm y Approved forms will be inserted in the chart/given to watcher; rejected forms will be returned to the drop box I. MEDICAL ONCOLOGY y Definite histologic diagnosis is not mandatory but preferable before referring y Drop at Med Onco Office near ECG station (open during office hours and when a fellow is around) J. PULMO y Strictly indicate specific reason for referral and not just for co-management (e.g. for possible bronchoscopy) y CXR should be @ bedside y Referrals should be signed by service senior (if from Medicine service) or by RIC (if from another department) y Logbook located outside Pulmo Office near ECG station K. RENAL y Special referral form available at Renal Office th or Dialysis Unit (both at the 6 floor) y Should be signed by service senior if from the Medicine Department th y Logbook located inside Renal Office 6 floor (open during office hours or when a fellow is around) L. RHEUMA y Drop at Rheuma office at the back of W1 y Should be signed by service senior if from the Medicine Department Department of Neurology y Include complete neurologic exam (GCS, MSE, CN, Motor, Reflexes, Sensory, Cerebellars, Autonomics, Meningeals) y Have W5 nurse-on-duty countersign forms then drop at Ward 5 Neurology office (located at the mezzanine, between W5 and W6) y Pedia Neuro (Dept of Pediatrics): drop box at the back of W11 Department of Neurosurgery y Include complete neurologic exam y Drop referral at NSS-ICU located at W6 y Text short endorsement to the NSS resident whose number is indicated in the log book Department of Obstetrics and Gynecology A. OB-GYN y Include pertinent OB-GYN history and PE (including IE) y Drop at OB residents lounge at back of W14B before 7am otherwise it will be seen the next day B. Gyne Onco y Indicate operative technique and operative findings [description of abdominal organs (including paraaortic LN), gross description of pathology, residual tumors location and size and volume in cubic cm.] y If post-op: include histopath report and stage of disease y If post-EL: indicate % of residual tumour y For virgin cases of cervical CA: include the following labs [ CBC, urinalysis, BUN, Crea, electrolytes, ALT, AST, CXR-PA, histopath results y Hand the referral personally to the Gyne Onco fellow for the day C. Trophoblastic Service

y Include histopath report and HCG titer D. Infectious Disease Service y Include temperature pattern y Drop at OB IDS office W15 Department of Ophthalmology y Include 5-point eye exam y Office hours: drop at front desk of SOJR y After 5pm: drop at desk of guard-on-duty Department of Orthopedics y Indicate handedness and occupation y Drop in respective sections dropbox located at the back of W8, no need for nurse-on-dutys countersign Department of Otorhinolaryngology y Logbook located at W10 nurses station, have the referral countersigned by nurse-on-duty y For follow-up referrals: indicate names of residents in the TEAM-in-charge y For post-op patients: indicate name of surgeon and assist Department of Pediatrics A. Gen Ped (for co-management) y Include weight, height, complete pediatric history (birth/maternal, immunization, nutritional, developmental, and personal/social history) y ER: Log at Pedia ER for decking to specific service then inform senior-on-duty and give referral personally y Ward: Logbook found at the back of W9 and W11, outside Pedia office B. For preop clearance y Logbook found at the back of W9 and W11, outside Pedia office y Log patient by 11am and instruct watcher/nurse that the patient should be brought to the back of W9 and W11 by 2pm (on weekdays or 10am on weekends) with the chart, lab results, and xray plates C. Subspecialties y Drop box and logbooks at back of Ward 11 y Pedia IDS (with special form): Pedia IDS office at W9 Department of Psychiatry y Use consultation liaison referral form available at W7 or with the Psych interns y Ward: have it countersigned by W7 nurse-on-duty before logging and inserting in logbook inside interns callroom (you may text the intern-on-duty if the callroom is locked) o Cut-off: 3PM y ER: call W7 nurses station, inform them of patients name, location, case, and referring resident Department of Radiology A. Interventional Radiology y Drop at Radio office B. Radiation Oncology y M-F Onco Room 103/105 at CI building Department of Rehabilitation y Include handedness and occupation, updated course in the ward, current meds, latest labs y Cardiac rehab: include initial and latest ECG, lab results and clearance from CVS y Drop at Rehab ward at the back of W5 Department of Surgery y Log referrals at W4 table near nurse station & drop at respective box outside W4 entrance y Follow specific instructions indicated in the drop boxes of certain divisions Cancer Institute (Radiotherapy Planning) y Referral slip (available at CI Rm 108) + clinical abstract y Histopath slides and results, x-ray plates/results, photocopy of case record, latest CBC and U/A results Toxicology y Include toxin and amount ingested; submit actual toxin if possible y Drop box at National Poison Control and Information Service (entrance of W14A) Dentistry y Drop at ACU-extension Dentistry table DNET/Dietary/Stoma Nurse y c/o nurses

PGH Tips for Diagnostic Exams

y Completely fill out lab request forms (name, age/sex, case number, location, birthday, diagnosis, specimen submitted, lab test to be requested, TRODAT with signature. y Special Cases: a. Blood typing and cross matching: (see Blood Bank section) b. ABG: include FiO2, Hgb, and Tr y Try to write legibly always. y Always label the samples completely. y Before extracting blood or collecting samples, always check the identity of the patient, and take time to explain the relevance of the test. y When submitting specimens, always ask the watcher to bring the BLUE and WHITE cards or else the specimens will not be accepted. y If you re ever in doubt as to how to properly collect and store your sample, you can call up Lab Info (3209) y For other lab-related inquiries, call local 2352. y TIP! When buying vials, always get the ones with the least amount of blood required will come in handy especially when you re extracting from a child or a very old patient.
Central Laboratory
STAT requests: y Have lab personnel log the specimen first then personally place the vial inside the respective room Following up results: y Load lists and results are printed and available outside each room y Culture studies: check respective logbook in Microbiology room HEMATOLOGY y CBC tubes violet top (2ml) y PT/PTT tubes blue top (1.8ml) y Shake in figure of 8 to allow the anticoagulant to mix with the blood y Do not fill the vial beyond the line marked CLINICAL CHEMISTRY y Plain tubes - red or gray cap y For free vials, you may ask for used vials from the clinical chemistry room MICROSCOPY y Urine vials o For GS/CS = use sterile vials o For urinalysis = cleaned vials available at the microscopy room y Unsterile collection o Midstream catch o Drain from Foley catheter y Sterile collection (use autoclaved vials) o Straight catheterization - drain only, do not balloon o Foley catheterization - apply betadine on catheter, puncture with new syringe on any part proximal to the bifurcation and aspirate MICROBIOLOGY Blood culture studies: y Have watcher pay lab request and instruct him/her to get CS bottles from lab info (specify if pediatric or adult) y Adult = 5 cc blood, Pedia = 1 cc blood y Aseptic technique o Use sterile gloves o Clean with betadine-soaked cotton before extracting blood o May use new needle to transfer blood from syringe to CS bottle y Preliminary report released after 1 day of submission, final report on Day 5

y STAT blood typing: results are available in as early as 15 minutes provided you personally request the blood bank personnel to prioritize your specimen RIV forms y Accomplished by RICs and RODs ONLY y Once the RIV is approved, it is the nurses responsibility to instruct watcher/facilitate retrieval of blood products from the blood bank y Your responsibility is ONLY to extract blood for cross-matching

schedule ECG Wait for the roving ECG personnel who will take the patients ECG bedside y If no watcher is available, call ECG office and leave patients name and location 2-D Echo, Doppler Studies y CVS Office located at 6th floor, c/o Maam Rose y Scheduling only on Weekdays, 8am to 4pm

MSS for Financial Assistance

Dear MSS, Date I would like to refer (patient name, location, assessment) to your office for financial assistance for his/her tests/meds. (Staple lab requests with prices appropriate for type of classification) Thank you. Your Name

Arterial Blood Gas

ABG ROOM (2/F, near Ward 14B) y How to do it: o Have watcher pay lab request o Heparinize a 1 cc syringe (aspirate from the heparin vial and coat the entire syringe and leave 0.01-0.05 cc of heparin collect at least 0.7 cc blood sample stick the needle into a rubber stopper and bend the needle Soak the syringe in iced water/cold water Label the syringe Make sure you add the following to the request form: Fi02 (21% if room air),Hgb and T r Ask the watcher to send specimen to ABG room and WAIT for the results y FiO2 = (O2 per L) x 4 + 20 o Ex. O2 is given at 5 lpm via FM: 5 lpm x 4 + 20 = 40% FiO2

Radiology
*SICs usually conduct only Q2, Q1, and volatile patients, but unstable patients are usually not brought to Radiology unless procedure is very necessary* X-RAY y Have the watcher schedule the patients xray (or if emergency, you may do it) at Radiology (Palistahan Window 1 if during office hours, Window 4 if after office hours). BRING BLUE CARD y If patient is for x-ray, do NOT forget to bring the blue card, request form, and old plates. y When endorsing to radio resident, be ready to identify yourself as ___(rotation) intern and give the patients age, sex, short history and present working impression; ask for the FINAL impression (that which you will report to your RICs or seniors, or note in chart) y When rotating in Trauma/Surgery, always bring with you extra copies of X-ray request forms and borrowers receipt and have your resident trodat the blank sheets ahead of time. Youll never know when an additional x-ray will be requested! y Give the stamped/approved copy of the request form to the nurse of the ward so she can instruct the utility personnel (manong) to conduct the patient y You may get the official reading at Window 1 ONLY on weekdays y You may get the wet reading at Room 5 anytime during the day; if locked during SHO days, call 3104 ULTRASOUND (Room 19, Radio) y Room 19 scheduling and retrieval of official UTZ results y Dont forget to bring your patients chart and tissue paper to wipe the lubricant over the area examined. y Radiology does not perform emergency ultrasound UNLESS it is paid! CT-SCAN y SOAP required at the back of the request y Open weekdays 7am to 10pm y Radiology does not perform emergency CT scan UNLESS it is paid! y Provisional reading may be available within 30 minutes after scan Borrowers receipt - requires signature of RICs and RODs - needed to borrow plates and put them at bedside

Price List for Class D (White Card) as of March 2009 HEMATOLOGY Room 4 Central Lab CBC with pc, dc, WBC, RBC, Hct, Plt, Malaria Free smear, ESR, retic count Protime (PT) 80 Prothrombin Time (PTT) 100 CLINICAL MICROSCOPY Room 2 Central Lab Urinalysis, urine pH, sugar, alb, specific grav Free Fecalysis Free Pregnancy Test 105 CLINICAL CHEMISTRY Room 3 Central Lab FBS, RBS, Crea, Na, K, Cl, plasma K, amylase Free BUN, uric acid, total chol, LDH, Ca, Mg, 20 each TPAG (total protein, albumin, globulin) 40 Ionized Ca 160 HbA1c 315 LFT 135 Trop I 220 AST 30 Trop T (quali) 200 ALP 25 Trop T (quanti) 1200 ALT 25 CK-MB 150 TB/DB/IB 30 each CK-Total 50 MICROBIOLOGY Room 6 Central Lab Gram stain, AFB, KOH, India Ink 20 AFB culture, fungal, blood & urine culture 100 IMMUNOLOGY T3 110 CRP (quali) 50 T4 110 ASO 50 TSH 120 Hepa Profile 820 PSA 250 HBsAg 80 CEA 250 Anti-HBs 130 CA-125 495 Salmonella 650 IgG/IgM CA-19 600 Dengue IgG/IgM 750 D-dimer 850 Leptospirosis 510 IgG/IgM BLOOD BANK Blood typing 24 Plasma, FFP, Free cryoprecipitate, Cross-matching 60 wRBC Hep B screening 80 Hep C screening 220 pRBC 200 HIV screening 100 Platelet conc. 100 Coombs Test 76 Whole blood 200

PGH TRUNKLINE: 5548400 FOOD DELIVERY DIRECTORY

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BLOOD BANK
Blood typing, Cross matching y Plain tubes only y Write name of extractor, date and time on the label and lab request form

ECG, 2D Echo & Cardiac Studies

ECG y Office located near Ward 3, on the way to OPD, beside radioisotope y Ask the watcher to bring blue card, white card, and ECG request form to the ECG office and

Edited by: Block O (2012 PGH Interns)

Special thanks to: Beverly Ho, Frances Vera Bernardino,
Rochelle Castillo, Glaiza Santillan, Angelo Manalang, Jason Brian Zafranco