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Inpatient Consults

PROCEDURE FOR INITIATING CONSULT

  1. Place the ID Consult in CPRS (choose "Consults for INPATIENT Infectious Disease care" under the ID Consults Menu)
  2. Call the ID consult fellow (x40270 or the VA ID Fellow virtual pager x89321 in the UCLA paging system). This will ensure clear communication of issues and questions as well as possible initial recommendations for empiric therapy and additional diagnostic testing.

NOTES

  • All inpatient consults are seen within 24 hours.If patients are unstable, they are evaluated urgently (please call the ID consult fellow immediately in this situation).
  • Some issues call for mandatory ID consultation, such as positive blood cultures for Staphylococcus aureus.

GUIDE TO ROTATING ON THE ID CONSULT SERVICE

Outpatient Clinics

CLINIC SCHEDULE
There are 5 ID clinics per week:

  • Monday 8:30 AM - 12:00 PM (LAOCC): General ID and Immunodeficiency (HIV)
  • Tuesday 1:00 PM - 4:30 PM (WLA): Immunodeficiency (HIV)
  • Wednesday 8:30 AM - 12:00 PM (Sepulveda): General ID, Immunodeficiency (HIV), Hepatitis
  • Friday 8:30 AM - 12:00 PM (WLA): General ID and Immunodeficiency (HIV)
  • Friday 1:00 PM - 4:30 PM (WLA): Hepatitis (in conjunction with GI section)

PLACING APPOINTMENTS
For clinic appointments, place an ID consult (choose "Consult for OUTPATIENT Infectious Disease care" under the ID Consults menu) and then contact the Infectious Diseases/HIV Program Office at x83763.

IMMUNODEFICIENCY (HIV) CLINICS
HIV-infected individuals at the West LA facility are followed as primary care patients by the ID section. The Tuesday afternoon clinic is structured specifically with HIV care in mind. At this clinic, a psychiatrist is available for mental health issues. HIV-infected individuals can also be followed at Monday, Wednesday or Friday morning clinics depending on patient's schedule and/or location restrictions. However, patients followed at Sepulveda and LAOCC ID clinics must be followed by Primary Care as well.

PRE-EXPOSURE PROPHYLAXIS
Pre-exposure prophylaxis (PrEP) is effective greatly reducing rates of HIV infection in those at high risk for acquisition. The ID section offers PrEP counseling, initiation and follow-up in clinics on Monday (Downtown), Wednesday (Sepulveda), and Friday (WLA).

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ID E-Consults

Some non-urgent issues may be appropriate for E-consults, which may be submitted through CPRS. When placing an E-consult, a specific question should be posed and adequate information needs to be provided. For travel medicine consults it is important to provide details of the trip, including dates and specific locations within a particular country (Will there be rural travel? For how many days? Activities?).

Common E-consults include:

  • Consideration for treatment of latent tuberculosis (i.e., positive PPD or QFTB)
  • Travel medicine (please note that the CDC maintains an excellent reference travel site at www.cdc.gov/travel)
  • Interpretation of laboratory results (e.g., cultures, RPR, etc.)

E-consults should NOT be submitted for:

  • Acute issues requiring intervention in <48 hours
  • Management of skin and soft tissue infections (these patients need to be evaluated in person)
  • Patients needing to be seen either in clinic or by the inpatient consult service

Outpatient Parenteral Antibiotic Therapy (OPAT)

Referrals for OPAT for inpatients being discharged from other hospitals:

All requests for GLA OPAT services will go through the GLA Nursing Off Tour Supervisor (OTS) office (x83568).  The GLA OTS office will contact the Infectious Diseases fellow on call (UCLA pager:  (310 206-8477 #89321).  All cases will be staffed by the Infectious Diseases attending on the consult service.  Assistance with technical issues will be provided by Drs. David Beenhouwer and Christopher Graber. 

  • Evaluations for OPAT can be arranged Monday – Friday; 24 hours advance notice is required to assure adequate review

  • The OTS office will be responsible for obtaining the information necessary for case review

  • Infectious Diseases will write a note in the medical record briefly summarizing the case and the decision regarding acceptance into the OPAT program. 

  • For cases not accepted in the GLA OPAT program, Infectious Diseases will document what further medical record information is required and/or whether additional diagnostic testing or therapeutic interventions are needed to determine the appropriateness and safety of OPAT.  Infectious Diseases will specify whether such testing or interventions need to be done on an inpatient basis prior to acceptance into the GLA OPAT program.  If such testing or interventions cannot be done at the referring hospital or if the information cannot be obtained, to ensure patient safety and well-being, Infectious Diseases will recommend that the patient be transferred to GLA for further care.

Referrals for OPAT for outpatients seen at GLA clinics who have already been discharged from other hospitals and who are transferring management of their antibiotic therapy to VA:

Initial contact should be Dr. Beenhouwer (primary) followed by Dr. Graber.  If neither are available question should be directed to the Infectious Diseases consult attending.  If safety questions arise, patients will be instructed to report to the ED so that they can be admitted for further evaluation and management.

Requests for OPAT from within WLA:

The ID consult service will evaluate for appropriateness of OPAT and leave a note in the chart.