Downtime Documentation
H&P will be documented on paper using DEM Physician Record (OV1901). Resident and Attending signatures are required.
MSE - when performed by a separate MSE provider, note should be very brief and be written on the upper portion of the History section of  the paper DEM Physician Record (OV1901). It should include a separate header of MSE NOTE and must be signed.
Downtime General Orders
orders should be written on paper using DEM Physician’s Orders (OV1337) and include a date, time, initials, and signature
orders should be placed in the order bin located at each Nursing Station (ED 1-5, RME) for the Nurse/Clerk to initiate
clerk has all downtime forms, lab slips and Radiology Request forms.
Downtime Radiology Orders
order imaging on paper and include a complete paper Radiology Order Form (OV2059). Runner will hand deliver request to the appropriate ED radiology area.
if ORCHID downtime is isolated, iimages and preliminary results will still be available in Synapse even if not viewable in ORCHID
radiology orders ordered during downtime using the Radiology Request forms do NOT routinely need to be re-entered into ORCHID after ORCHID comes back up (exceptions may occur).
Downtime Laboratory Orders/Workflow
clerk/nurse will complete paper lab request slips to accompany specimens sent to the lab. The lab slip should include collector's employee number ("e" or "c" number).
lab labels will not print during downtime. All specimens must be labeled with the following information:
patient info: patient name, DOB, MRN, FIN
collector's info: date/time specimen collected, employee number ("e' or "c" number), collectors signature
lab results will be faxed to the ED at X74298 and hand delivered to the assigned resident or attending for that patient
POCT orders placed by the providers will be resulted verbally to the ordering provider and also resulted in nursing documentation
lab will call critical results to the ED
lab orders ordered during downtime do NOT routinely need to be re-entered into ORCHID after ORCHID comes back up (exceptions may occur). Results that came back on paper will eventually also be resulted in ORCHID.
patient info: patient name, DOB, MRN, FIN
collector's info: date/time specimen collected, employee number ("e' or "c" number), collectors signature
Downtime Medication Orders
all medication orders should be written on paper using form OV1337
patient prescriptions should be written on paper and handed to the patient. A copy of each Rx should be kept in the patient’s paper record. Rxs will be scanned into ORCHID once ORCHID comes back up. Rx’s will not be back entered by the provider into ORCHID after a prolonged downtime.
when ORCHID is back up, Pharmacy will manually enter all medications that were ordered during downtime
Downtime Blood Bank Orders
enter required orders on paper (T&S, T&C, transfusion, etc)
paper blood transfusion indication sheet must be filled out for Adults OV1998 or Peds (OV2015)
Downtime Specialty Diagnostic Services
complete paper requisition for Echo, Stress Treadmill/Myocardial Perfusion Imaging, Holter and EEG. Call appropriate department for STAT orders
Downtime Admissions
initiate Interqual request by calling UR directly at X74890.
discuss with admitting team
once an admission is accepted by the admitting team, enter Request to Admit order on paper and include service, level of care, and the name of the admitting attending and resident.
admissions during downtime will be tracked by Nursing on a paper log
certain orders such as Bed Requests and Admit Orders will need to be manually re-entered into ORCHID once ORCHID is back up
Downtime Discharge
complete discharge and aftercare instructions using form OV2014 including discharge impression, recommended follow up, and return precuations. Do not use this form for Rx.
Rx should be written on paper Rx pads. Copies should be left in paper chart to be scanned in later.
discharge order must be signed on paper
all discharges from the ED during downtime will be tracked by Nursing on a paper log. A separate provider log will be kept for downtime discharges that require future labs, studies, message pools, e-consults, TFU referrals so that they may be entered into ORCHID during recovery.
Downtime Recovery - ORCHID Back Online
LAB/RAD - results will begin to populate via the interface in ORCHID. Lab and imaging orders previously placed on paper should not neeed to be ordered again.
documentation – Provider documentation on paper will be scanned into patient chart.
pharmacy will back-enter enter all medication orders placed on paper during downtime back into ORCHID.
physicians must re-enter all other paper orders placed during downtime into ORCHID (admission requests, place in obs, isolation, communication, restraints, holds, consults, etc).
Downtime Frequent Phone Numbers
ED Lab (8:30 am - 10:30pm) : 74977
General Lab: 73476, 74038
Microbiology: 76041
Blood Bank: 	74062
Phlebotomy:  74555/74039
ED Xray Tech: 75496
ED US Tech: 74940
ED CT Tech: 74968
MRI Tech: 73535
ED Radiologist: 74971
StatRad Coverage for CT and MRI Overnight and Weekend Reads Only - 858-546-3800, press 1.
USROC Coverage for Ultrasound Overnight and Weekend Reads OnlyMonday-Friday 11p-7a and Weekends/Holidays 7p-7a 866-448-7762
ED UR/Interqual: 74890
Pharmacy: 73070
ED1A: 74320
ED1B: 74865
ED2A: 74321
ED2B: 74280
ED3: 74976
ED4: 74974
ED5: 74970
SuperTrack Provider Room : 74936/74937
Main Provider Room: 73645
DEM Administrative Offices: 73107
OVMC:ED
RRMC:ED
SCVMC:ED
SCVMC:EXC
SCVMC:Main
MHH-TMC
Tdap
Harbor Macros: AMA