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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 non-VA hospitals:

All requests for GLA home IV antimicrobial services will go through VA GLA ID OPAT team. The primary care provider should enter the following consults listed below at least 24 to 48 hours from anticipated discharge date. The VA GLA OPAT Team will review case based on OSH records (Fax: 310-268-4928). For any questions or assistance please contact Ashni A. Patel, PharmD or Phuong Khanh Nguyen (WLA), PharmD.

  • OPAT consults to be entered by primary care provider:

    • ID Outpatient Parenteral Antibiotic

    • Home Care Services

  • Evaluations for OPAT can be arranged Monday – Friday (e.g., consults entered after 2:00PM will be processed next business day)

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

Note: Inaccurate or incomplete information may lead to delays in OPAT arrangement.

Referrals for OPAT for inpatients within WLA or outpatients seen at GLA clinics:

Inpatient: The ID consult service will evaluate for appropriateness of OPAT and leave a note in chart. Based on ID consult service recommendations, the primary inpatient team should enter the following consults at least 24-48 hours prior to discharge: (1) PICC Insertion (ID PICC approval note required), (2) ID Outpatient Parenteral Antibiotic, and (3) Home Care Services          

Note: Successful radiographic PICC confirmation is a pre-requisite for Home Health agencies prior to accepting cases. Turnaround time for PICC insertion is 2-3 days business days per infusion center.

Outpatient: For non-urgent indications, patient should be evaluated at outpatient ID clinic. ID team will notify OPAT team for arrangements, if appropriate. For urgent indications, follow the procedures for discharge from non-VA hospitals above.