Harbor:Expedited workup clinic

Background

The Expedited Workup Clinic (EWC) is an option for patients who are stable but require close outpatient follow-up for further diagnostic evaluation (ex. uncharacterized mass, anemia, etc). These are patients that would have been admitted otherwise, but are clinically stable. The EWC is for patients who do not have a primary care provider and must have reliable contact information.

How to Book

• Clerk to book HAR CCC/Appointment type is CONTINUING CARE NEW. It will show HAR CCC-EXPEDITED WORK UP.
• If no appointments left for EWC, then refer patient to CCC.

Requirements for direct scheduling

New onset ascites

This must be a new diagnosis and first presentation of ascites. Requires paracentesis performed in ED to rule out infection, SAAG >1.1, transaminases < 3x normal, rapid HIV, CBC, lipase, CMP. No referral for therapeutic paracentesis alone, No evidence of pancreatitis or biliary obstruction.

Anemia (Hgb< 8g/dL on initial presentation)

Requires CBC, peripheral smear, CMP, rapid HIV, ECG, CXR, type and screen No evidence of pancytopenia, HIV, leukemia, active GI/GU bleeding, or evidence of hemolysis. Patients with suspected gynecologic etiology should be referred to the GYN service. Post transfusion CBC required.

Weight loss, unexplained >10% within 1 month or >15% in 6 months

Requires CBC, CMP, ECG, CXR, rapid HIV. Patients with prior imaging must have actual images or be instructed to retrieve images prior to clinic appointment.

Undiagnosed mass (excluding primary breast, head and neck, renal, and brain masses)

• Contact the appropriate surgical service for primary breast, head and neck, renal, and brain masses
• Requires results or radiographic imaging to confirm presence of mass. Patients with prior imaging must have actual images or be instructed to retrieve imaging prior to clinic appointment.

New onset pleural effusion

Requires thoracentesis, CMP, CBC, serum amylase, LDH, and pleural fluid analysis (predominant lymphocytic effusion or high suspicion for Tuberculosis must be admitted). Chest CT only if immediately clinically indicated (ie. suspicion for pulmonary embolism).

Clinical Criteria:

• Patient is stable (T< 38.3c, HR<100, RR <24, BP >110/50, BP <180/110, pulse ox >92% on room air, oriented x 4)
• Able to be seen in 2-10 business days without significant risk
• No ACTIVE co-morbidities (ie infection, CAD, CHF, stroke, metastatic cancer, renal failure, dyspnea).
• Patient has reliable contact information.

See Also

• Harbor:Main
• Harbor:ED follow-up options