Guide to YKHC Medical Practices - User contributions [en]

Respiratory/Cardiopulmonary Services

2023-03-02T21:53:16Z

JenniferH:

The respiratory therapy department
*Location: the main hospital off the lobby located in the inpatient unit
*On call 24 hours/day
*How to contact: use Tiger Connect "Respiratory Therapy Team 4284"
*Provides/coordinates routine respiratory management in all areas of the hospital
*Services include:
**Holter monitor placement
**pulmonary function tests
**nebulizer distribution
**cardiac stress testing
*Provides respiratory management of critical patients on ventilators until patient can be transferred to higher level of care.

[[file:Cardiopulmonary_Testing_Processes.PNG]]

[[media:How_to_Obtain_Cardiopulmonary_Testing.pdf|Cardiopulmonary Testing Workflow (same as above diagram)]]

Ischemic Stroke – Acute

2023-02-13T18:42:18Z

JenniferH: /* YKHC Stroke Clinical Guideline Development */

Generally speaking, all acute CVA patients should be transferred from ER to ANMC for full stroke workup and better access to consistent PT/OT/SLP.

Patients who decline transfer, particularly those without hemorrhage who have returned to neurologic baseline, could be monitored for 1-2 days at YKHC to monitor for worsening, screen for arrhythmia on telemetry, and work with our physical therapy colleagues. These patients should then be referred to ANMC neurology for MRI, echo, and carotid imaging (if not done in Bethel).

===YKHC Stroke Clinical Guideline Development===
Drs. Jeremy Wood and Peek Ehlinger created the YKHC stroke guideline with the goal of improving care for our patients treated both in the YKHC hospital and nearby region. One of the goals was to encourage earlier identification of strokes that may be amenable to thrombectomy. The emergence of an intervention for large vessel occlusion strokes has changed the diagnostic pathway and treatment algorithm for stroke. It is an area of active development that we should expect will change over the next few years.

Thrombectomy for appropriate large vessel occlusion strokes appears to have a much more hopeful risk versus benefit ratio than does thrombolytics for the undifferentiated ischemic stroke, however, in general the area of stroke treatment has a fair bit of controversy and you will likely hear different things from different people. We tried to emphasize the importance of bringing neurology along in this decision, and it’s OK to defer to them.

Thrombolytics have been shown to provide net benefit in a select group of patients, however, they also can harm at rates that increase due to a number of factors, such as time from stroke onset (i.e. data stronger for <3 hours than between 3 and 4.5) and patient specific risk factors. Be sure to take your time with the exclusion criteria and consideration of stroke mimics.

We currently have stocked tenectaplase in the ED, which is the direction that most stroke centers are going.

====Shared Decision Making====
Shared decision making is often difficult in a patient with a disabling stroke and may not be necessary or possible in all patients. As the patient may not have capacity to participate in decisions, you may need to enlist the help of a surrogate decision maker or proceed under presumed consent in such cases when the benefits clearly outweigh the harms. The included consent form is a suggested reference to review anticipated risks and benefits. There is an online resource that has been clinically validated ([http://www.sorcan.ca/iscore/ iScore]) which also may be of some use.

'''Verbal Consent example from UpToDate'''
*"There is a treatment for your stroke called alteplase that must be given within 4.5 hours after the stroke started. It is a 'clot-buster' drug. Getting alteplase reduces your risk of being disabled. People who get alteplase for stroke have a better chance of recovering without disability and getting back to the activities they enjoy compared to people who do not receive the treatment. All medicines have some risk. With alteplase, there is a risk of serious bleeding. However, time is important as well. We know that the sooner we start treatment with alteplase, the greater the chance that patients will have a good outcome."

====Revision of Written Consent form—numbers from Lancet 2014 article====

'''Benefits:'''
*< 3 hours: 33% of stroke patients given alteplase had good outcome, whereas 23% of stroke patients controls (no alteplase) also got better. 10 people would have to get the drug to help 1 person have a good outcome.
*Between 3 and 4. 5 hours from stroke onset: 35% of patients receiving alteplase had a good outcome, and 30% of patients who didn’t get the drug also got better. You would have to treat 20 people to help 1 person have a good clinical outcome.

'''Risks:'''
*In large series of stroke patients, 6.8% of them had bleeding in their brain after receiving alteplase for stroke, versus 1.3% of those stroke patients who did not receive the drug. If we give this drug 18 times, chances are it will make one person have bleeding in their brain.
*2% of people given this drug die from a hemorrhage (absolute risk) however by 3-6 months out those that receive the drug within 3 hours have a 10% (absolute increase) increased chance of disability-free survival, and that drops to 5% between 3 and 4.5 hours.

===Resources/References===
* [[media:Stroke.pdf|Acute Ischemic Stroke YKHC Clinical Guideline]]
* [[Stroke (CVA)|Stroke RMT Guide]]
* [http://www.sorcan.ca/iscore/ iScore]
* Siket Matt, Marcolini Evadne, Ganti Latha. [https://www.emrap.org/corependium/chapter/recEAr4nPXQE4eOBH/Transient-Ischemic-Attack-and-Acute-Ischemic-Stroke Transient Ischemic Attack and Acute Ischemic Stroke.] In: Mattu A and Swadron S, ed. CorePendium. Burbank, CA: CorePendium, LLC. https://www.emrap.org/corependium/chapter/recEAr4nPXQE4eOBH/Transient-Ischemic-Attack-and-Acute-Ischemic-Stroke.
* Emberson J et al.; Stroke Thrombolysis Trialists' Collaborative Group. [https://www.sciencedirect.com/science/article/pii/S0140673614605845?via%3Dihub Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials.] Lancet. 2014 Nov 29;384(9958):1929-35. doi: 10.1016/S0140-6736(14)60584-5. Epub 2014 Aug 5. PMID: 25106063; PMCID: PMC4441266.
* [[media:Alaska Stroke Systems of Care 7.29.17.pdf|Alaska Stroke Systems of Care]] (PowerPoint Presentation)

[[:category:YKHC Guidelines|YKHC Clinical Guidelines]]
 [[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]

Specialty Referrals

2023-02-02T04:17:11Z

JenniferH: /* OB/GYN Referrals */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)
'''Clinics Available'''
*ANMC Cardiology
**all referrals are reviewed for possible scheduling at Bethel Field Clinic
''any time you consult with a Cardiologist at ANMC who requests that a patient be seen in the cardiology field clinic at YKHC, please send the patient information over to Case Management to coordinate scheduling''

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Derm requires pictures

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Developmental (Pediatric)==
'''Orders Available'''
*Refer to Family, Infant, Toddler Program Internal
*Refer to Child Family Developmental Services External
*Refer to Peds Other External (Ability Clinic)
see [[Specific_Types_of_Appointments_and_Procedural_Processes#Developmental_Delay|Specific Pediatric Processes Section about Developmental Delay]] for more details.

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Adult)==
'''Orders Available'''
*Refer to Adult Gastroenterology External
'''Clinics Available'''
*ANMC Gastroenterology Clinic
*Internal Medicine Associates

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, please contact the gyn case manager by sending a communicate to Women’s Health Case Mangers pool in Powerchart .

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call the gyn case manager – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. The gyn case manager can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-02-02T04:14:49Z

JenniferH: /* Dermatology */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)
'''Clinics Available'''
*ANMC Cardiology
**all referrals are reviewed for possible scheduling at Bethel Field Clinic
''any time you consult with a Cardiologist at ANMC who requests that a patient be seen in the cardiology field clinic at YKHC, please send the patient information over to Case Management to coordinate scheduling''

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Derm requires pictures

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Developmental (Pediatric)==
'''Orders Available'''
*Refer to Family, Infant, Toddler Program Internal
*Refer to Child Family Developmental Services External
*Refer to Peds Other External (Ability Clinic)
see [[Specific_Types_of_Appointments_and_Procedural_Processes#Developmental_Delay|Specific Pediatric Processes Section about Developmental Delay]] for more details.

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Adult)==
'''Orders Available'''
*Refer to Adult Gastroenterology External
'''Clinics Available'''
*ANMC Gastroenterology Clinic
*Internal Medicine Associates

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Tiger Connect

2023-02-02T04:13:43Z

JenniferH: /* Groups */

==Overview==
Tiger Connect has replaced pagers at YKHC. It is automatically installed on your PowerChart/FirstNet desktop and you should also install this on your regular desktop. It can be installed on your personal phone as well.

Tiger Connect allows you to text within YKHC and to ANMC. You can text individuals as well as groups. Roles may be assigned as well and as providers go on/off duty, they will transfer the ‘role’ to the subsequent provider.

==Roles==
Roles may be assigned as well. As providers in these roles go on/off duty, they will transfer the ‘role’ to the on coming provider.

===COVID===
{| class="wikitable" style="width: 90%; margin: auto;"
!NAME OF ROLE!!WHY TO USE IT!!WHEN TO USE IT
|-
|style="width: 25%"|COVID-19 Response Team
|style="width: 50%"|
|style="width: 25%"|24 hours a day, any day
|-
|PPE COVID-19||to communicate need for PPE if not available from department stock||24 hours a day, any day
|-
|Scheduling COVID-19|| ||
|}

===EMERGENCY SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Administrator on-call||To request approval for YK pay for patients who do not meet preapproved criteria. (On nights and weekends, you can use the RMT or ED doctor’s name for urgent travel.)||24 hours a day, any day
|-
|CHAP on Call|| ||
|-
|Child Abuse on Call|| ||24 hours a day, any day
|-
|Clinical Director on-call ||For CD on call issues, and, if you are a hospitalist, to call in sick||24 hours a day, any day
|-
|Clinician Ethicist on-call|| ||24 hours a day, any day
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Ethics Committee On Call|| ||24 hours a day, any day
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|Psych Inpt On Site (not for patients) || ||
|-
|SART Adult On Call|| ||24 hours a day, any day
|-
|SART Peds On Call|| ||24 hours a day, any day
|}

===IT DEPARTMENT===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|IT Manager On Call||Use if you can’t get a hold of a tech via x6070 or TigerConnect, or if you need to escalate ||8am-8pm
|-
|IT Network on Call||For internal use only ||
|-
|IT RAVEN On Call||Use if it is not practical to call and you know it’s a RAVEN issue. ||8am-8pm
|-
|IT Service Desk On Call x6070||Providers should use when it is too urgent for a ticket but not convenient to stay on the line with a tech. (e.g. when they are with a patient)||8am to 8pm
|}

===LONG TERM CARE (LTC)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|LTC (Elders Home) Doc||The physician that staff at LTC should contact when they have medical questions about a LTC resident ||
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|}

===NURSE ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Charge Nurse A/B/C||Any questions about a patient being seen in OPC. Patients who need to be seen via nurse only clinic. Pharmacy TT to see which tube station to send meds to. ||8am-5pm, Monday-Friday (except Holidays)
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|NW Charge Nurse On Duty|| ||24 hours a day, any day
|-
|OB Charge Nurse On Duty||For the providers to alert the charge nurse of patients that are on their way to the unit( from village or clinic), or to ask questions of the charge nurse on duty ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH||to contact Women's Health Case Manager on duty ||
|}

===OPERATING ROOM (OR)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|}

===PHARMACY ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|BH Pharmacy On Call||The pharmacist that staff at our BH residential facilities should contact when they have medication questions || 9am to 10pm, every day
|-
|Clinic A/B/C Pharmacist||to contact the clinic pharmacists that are located in Clinic A, Clinic B, and Clinic C teamrooms. see [[Pharmacy#Clinic_Pharmacist|Clinic Pharmacist]] for more details ||Monday-Friday 8:30am-5:30pm (except holidays)
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Inpatient Pharmacy On Call||to communicate about admitted patients, as well as ER and outpatient patients who need medication from the inpatient pharmacy. There may be some overlap between this role and the ER pharmacist role due to the fact that there is some overlap with regards to where in the building a medication comes from. If it’s an IV medication, the Inpatient Pharmacy on call will generally be the one to contact and if it’s an oral medication the ER pharmacist would be the right person. But don’t worry about that too much, the pharmacy staff will get you in touch with the right person. see [[Pharmacy#Inpatient_Pharmacist|Inpatient Pharmacist]] for more details ||24 hours a day, any day
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|-
|Outpatient Pharmacy 1 and 2||The pharmacists logged into these roles are the data entry pharmacists. They can be used to communicate with pharmacy staff regarding prescriptions that have been written, will be written, or to ask pharmacy related questions. see [[Pharmacy#Outpatient_Pharmacist|Outpatient Pharmacist]] for more details. ||8:30am-7:30pm, Monday-Friday (except holidays)
|-
|Village Ops Pharmacist||for pharmacy questions when doing village travel by CHAs, SRC providers, and providers. see [[Pharmacy#Village_Ops_Pharmacist|Village Ops Pharmacist]] for more details. ||8:30am-5:30pm, Monday-Friday (except holidays)
|}

===PROVIDER ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Audiologist On Call|| ||Available Monday-Friday
|-
|Dental on Call|| ||24 hours a day, any day
|-
|Endoscopist On Duty|| ||
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|Family Medicine Resident On Call||to contact the Family Medicine Resident ||24 hours a day, any day (for scheduled shifts)
|-
|Kusko Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Kusko Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|Optometry On Call||For emergency optometry consults||after 5pm weekdays, weekends, and holidays
|-
|Peds Wards on Duty||To communicate about any chronic pediatric patient (CPP) from any village, to consult for any pediatric patient, to summon a pediatrician for an emergency including attendance at a delivery.
'''RMT for any chronic pediatrics patient.'''
||24 hours a day, any day
|-
|Star Doc on-call||If you are the Night Float, use this to call in your back-up doctor for medevacs.||24 hours a day, any day
|-
|Yukon Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Yukon Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|}

===SUPPORT SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|CT Tech on Duty||to communicate any questions regarding CT exams. Also can be used to notify about inbound patients (i.e. ER pending arrivals) but emergent response is probably still best with a phone call (not all staff have TT on their cell phones). ||24 hours a day, any day
|-
|Halibut Hall Registration|| ||
|-
|Hostel|| ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH||to contact Women's Health Case Manager ||
|-
|RN CM on Call for Provider Call Out's|| ||
|-
|Scheduling Department on Call|| ||
|-
|Telehealth On Call Support|| ||
|-
|Travel On Call|| ||
|}

==Groups & Broadcast Lists==
{| class="wikitable"
!NAME OF GROUP!!WHY TO USE IT
|-
|'''Trauma Heads Up'''
||
*This is when we have a trauma coming in that allows us to make sure those that are on call to be on alert. You do not need to call back unless you have questions, this one is just an FYI
*Sender of a heads up message content - needs to enter in basic information, anticipated and ETA. If it gets cancelled please use this notification and “cancel” in message.
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trauma Level I Activation (full trauma activation)'''
||
*This would require all those on the list to come to the ER/or other location if different. Please do not call as this takes time away from staff already dealing with an emergent issue.
*Sender of Trauma level I activation message content – Location, anticipated needs, keep it short and sweet. (you may exclude any one from this list if you are sure you will not need them- example - EX-OR CRNA)
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trama level II Activation (modified trauma)'''
||
*Please send, it allows us to verify activation.
*Sender message – MRN, RM#
#ED Doc,
#RT
#CT Tech
#ED Charge Nurse
|-
|colspan="2"|***Charge nurses will be responsible for making sure the data gets placed in the green folder at the nurses’ station for any Trauma.
|-
|'''OR C-Section'''
||
*To quickly notify staff that would be needed in case of a C-Section
#Peds Wards On Duty
#OR CRNA On Call
#OR Circulating Nurse On Call
#OR Scrub Tech On Call
#RT On Call !!CORRECT!!
#OR Charge Nurse on Call
|}

==Text Duration==
Texts live for 3 days only and then will disappear, so it is not intended for permanent documentation.

Tiger Connect

2023-02-02T04:12:26Z

JenniferH: /* Text Duration */

==Overview==
Tiger Connect has replaced pagers at YKHC. It is automatically installed on your PowerChart/FirstNet desktop and you should also install this on your regular desktop. It can be installed on your personal phone as well.

Tiger Connect allows you to text within YKHC and to ANMC. You can text individuals as well as groups. Roles may be assigned as well and as providers go on/off duty, they will transfer the ‘role’ to the subsequent provider.

==Roles==
Roles may be assigned as well. As providers in these roles go on/off duty, they will transfer the ‘role’ to the on coming provider.

===COVID===
{| class="wikitable" style="width: 90%; margin: auto;"
!NAME OF ROLE!!WHY TO USE IT!!WHEN TO USE IT
|-
|style="width: 25%"|COVID-19 Response Team
|style="width: 50%"|
|style="width: 25%"|24 hours a day, any day
|-
|PPE COVID-19||to communicate need for PPE if not available from department stock||24 hours a day, any day
|-
|Scheduling COVID-19|| ||
|}

===EMERGENCY SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Administrator on-call||To request approval for YK pay for patients who do not meet preapproved criteria. (On nights and weekends, you can use the RMT or ED doctor’s name for urgent travel.)||24 hours a day, any day
|-
|CHAP on Call|| ||
|-
|Child Abuse on Call|| ||24 hours a day, any day
|-
|Clinical Director on-call ||For CD on call issues, and, if you are a hospitalist, to call in sick||24 hours a day, any day
|-
|Clinician Ethicist on-call|| ||24 hours a day, any day
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Ethics Committee On Call|| ||24 hours a day, any day
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|Psych Inpt On Site (not for patients) || ||
|-
|SART Adult On Call|| ||24 hours a day, any day
|-
|SART Peds On Call|| ||24 hours a day, any day
|}

===IT DEPARTMENT===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|IT Manager On Call||Use if you can’t get a hold of a tech via x6070 or TigerConnect, or if you need to escalate ||8am-8pm
|-
|IT Network on Call||For internal use only ||
|-
|IT RAVEN On Call||Use if it is not practical to call and you know it’s a RAVEN issue. ||8am-8pm
|-
|IT Service Desk On Call x6070||Providers should use when it is too urgent for a ticket but not convenient to stay on the line with a tech. (e.g. when they are with a patient)||8am to 8pm
|}

===LONG TERM CARE (LTC)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|LTC (Elders Home) Doc||The physician that staff at LTC should contact when they have medical questions about a LTC resident ||
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|}

===NURSE ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Charge Nurse A/B/C||Any questions about a patient being seen in OPC. Patients who need to be seen via nurse only clinic. Pharmacy TT to see which tube station to send meds to. ||8am-5pm, Monday-Friday (except Holidays)
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|NW Charge Nurse On Duty|| ||24 hours a day, any day
|-
|OB Charge Nurse On Duty||For the providers to alert the charge nurse of patients that are on their way to the unit( from village or clinic), or to ask questions of the charge nurse on duty ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH||to contact Women's Health Case Manager on duty ||
|}

===OPERATING ROOM (OR)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|}

===PHARMACY ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|BH Pharmacy On Call||The pharmacist that staff at our BH residential facilities should contact when they have medication questions || 9am to 10pm, every day
|-
|Clinic A/B/C Pharmacist||to contact the clinic pharmacists that are located in Clinic A, Clinic B, and Clinic C teamrooms. see [[Pharmacy#Clinic_Pharmacist|Clinic Pharmacist]] for more details ||Monday-Friday 8:30am-5:30pm (except holidays)
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Inpatient Pharmacy On Call||to communicate about admitted patients, as well as ER and outpatient patients who need medication from the inpatient pharmacy. There may be some overlap between this role and the ER pharmacist role due to the fact that there is some overlap with regards to where in the building a medication comes from. If it’s an IV medication, the Inpatient Pharmacy on call will generally be the one to contact and if it’s an oral medication the ER pharmacist would be the right person. But don’t worry about that too much, the pharmacy staff will get you in touch with the right person. see [[Pharmacy#Inpatient_Pharmacist|Inpatient Pharmacist]] for more details ||24 hours a day, any day
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|-
|Outpatient Pharmacy 1 and 2||The pharmacists logged into these roles are the data entry pharmacists. They can be used to communicate with pharmacy staff regarding prescriptions that have been written, will be written, or to ask pharmacy related questions. see [[Pharmacy#Outpatient_Pharmacist|Outpatient Pharmacist]] for more details. ||8:30am-7:30pm, Monday-Friday (except holidays)
|-
|Village Ops Pharmacist||for pharmacy questions when doing village travel by CHAs, SRC providers, and providers. see [[Pharmacy#Village_Ops_Pharmacist|Village Ops Pharmacist]] for more details. ||8:30am-5:30pm, Monday-Friday (except holidays)
|}

===PROVIDER ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Audiologist On Call|| ||Available Monday-Friday
|-
|Dental on Call|| ||24 hours a day, any day
|-
|Endoscopist On Duty|| ||
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|Family Medicine Resident On Call||to contact the Family Medicine Resident ||24 hours a day, any day (for scheduled shifts)
|-
|Kusko Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Kusko Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|Optometry On Call||For emergency optometry consults||after 5pm weekdays, weekends, and holidays
|-
|Peds Wards on Duty||To communicate about any chronic pediatric patient (CPP) from any village, to consult for any pediatric patient, to summon a pediatrician for an emergency including attendance at a delivery.
'''RMT for any chronic pediatrics patient.'''
||24 hours a day, any day
|-
|Star Doc on-call||If you are the Night Float, use this to call in your back-up doctor for medevacs.||24 hours a day, any day
|-
|Yukon Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Yukon Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|}

===SUPPORT SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|CT Tech on Duty||to communicate any questions regarding CT exams. Also can be used to notify about inbound patients (i.e. ER pending arrivals) but emergent response is probably still best with a phone call (not all staff have TT on their cell phones). ||24 hours a day, any day
|-
|Halibut Hall Registration|| ||
|-
|Hostel|| ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH||to contact Women's Health Case Manager ||
|-
|RN CM on Call for Provider Call Out's|| ||
|-
|Scheduling Department on Call|| ||
|-
|Telehealth On Call Support|| ||
|-
|Travel On Call|| ||
|}

==Groups==
{| class="wikitable"
!NAME OF GROUP!!WHY TO USE IT
|-
|'''Trauma Heads Up'''
||
*This is when we have a trauma coming in that allows us to make sure those that are on call to be on alert. You do not need to call back unless you have questions, this one is just an FYI
*Sender of a heads up message content - needs to enter in basic information, anticipated and ETA. If it gets cancelled please use this notification and “cancel” in message.
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trauma Level I Activation (full trauma activation)'''
||
*This would require all those on the list to come to the ER/or other location if different. Please do not call as this takes time away from staff already dealing with an emergent issue.
*Sender of Trauma level I activation message content – Location, anticipated needs, keep it short and sweet. (you may exclude any one from this list if you are sure you will not need them- example - EX-OR CRNA)
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trama level II Activation (modified trauma)'''
||
*Please send, it allows us to verify activation.
*Sender message – MRN, RM#
#ED Doc,
#RT
#CT Tech
#ED Charge Nurse
|-
|colspan="2"|***Charge nurses will be responsible for making sure the data gets placed in the green folder at the nurses’ station for any Trauma.
|-
|'''OR C-Section'''
||
*To quickly notify staff that would be needed in case of a C-Section
#Peds Wards On Duty
#OR CRNA On Call
#OR Circulating Nurse On Call
#OR Scrub Tech On Call
#RT On Call !!CORRECT!!
#OR Charge Nurse on Call
|}

==Text Duration==
Texts live for 3 days only and then will disappear, so it is not intended for permanent documentation.

Tiger Connect

2023-02-01T03:24:22Z

JenniferH: /* PROVIDER ROLES */

==Overview==
Tiger Connect has replaced pagers at YKHC. It is automatically installed on your PowerChart/FirstNet desktop and you should also install this on your regular desktop. It can be installed on your personal phone as well.

Tiger Connect allows you to text within YKHC and to ANMC. You can text individuals as well as groups. Roles may be assigned as well and as providers go on/off duty, they will transfer the ‘role’ to the subsequent provider.

==Roles==
Roles may be assigned as well. As providers in these roles go on/off duty, they will transfer the ‘role’ to the on coming provider.

===COVID===
{| class="wikitable" style="width: 90%; margin: auto;"
!NAME OF ROLE!!WHY TO USE IT!!WHEN TO USE IT
|-
|style="width: 25%"|COVID-19 Response Team
|style="width: 50%"|
|style="width: 25%"|24 hours a day, any day
|-
|PPE COVID-19||to communicate need for PPE if not available from department stock||24 hours a day, any day
|-
|Scheduling COVID-19|| ||
|}

===EMERGENCY SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Administrator on-call||To request approval for YK pay for patients who do not meet preapproved criteria. (On nights and weekends, you can use the RMT or ED doctor’s name for urgent travel.)||24 hours a day, any day
|-
|CHAP on Call|| ||
|-
|Child Abuse on Call|| ||24 hours a day, any day
|-
|Clinical Director on-call ||For CD on call issues, and, if you are a hospitalist, to call in sick||24 hours a day, any day
|-
|Clinician Ethicist on-call|| ||24 hours a day, any day
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Ethics Committee On Call|| ||24 hours a day, any day
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|Psych Inpt On Site (not for patients) || ||
|-
|SART Adult On Call|| ||24 hours a day, any day
|-
|SART Peds On Call|| ||24 hours a day, any day
|}

===IT DEPARTMENT===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|IT Manager On Call||Use if you can’t get a hold of a tech via x6070 or TigerConnect, or if you need to escalate ||8am-8pm
|-
|IT Network on Call||For internal use only ||
|-
|IT RAVEN On Call||Use if it is not practical to call and you know it’s a RAVEN issue. ||8am-8pm
|-
|IT Service Desk On Call x6070||Providers should use when it is too urgent for a ticket but not convenient to stay on the line with a tech. (e.g. when they are with a patient)||8am to 8pm
|}

===LONG TERM CARE (LTC)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|LTC (Elders Home) Doc||The physician that staff at LTC should contact when they have medical questions about a LTC resident ||
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|}

===NURSE ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Charge Nurse A/B/C||Any questions about a patient being seen in OPC. Patients who need to be seen via nurse only clinic. Pharmacy TT to see which tube station to send meds to. ||8am-5pm, Monday-Friday (except Holidays)
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|NW Charge Nurse On Duty|| ||24 hours a day, any day
|-
|OB Charge Nurse On Duty||For the providers to alert the charge nurse of patients that are on their way to the unit( from village or clinic), or to ask questions of the charge nurse on duty ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH||to contact Women's Health Case Manager on duty ||
|}

===OPERATING ROOM (OR)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|}

===PHARMACY ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|BH Pharmacy On Call||The pharmacist that staff at our BH residential facilities should contact when they have medication questions || 9am to 10pm, every day
|-
|Clinic A/B/C Pharmacist||to contact the clinic pharmacists that are located in Clinic A, Clinic B, and Clinic C teamrooms. see [[Pharmacy#Clinic_Pharmacist|Clinic Pharmacist]] for more details ||Monday-Friday 8:30am-5:30pm (except holidays)
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Inpatient Pharmacy On Call||to communicate about admitted patients, as well as ER and outpatient patients who need medication from the inpatient pharmacy. There may be some overlap between this role and the ER pharmacist role due to the fact that there is some overlap with regards to where in the building a medication comes from. If it’s an IV medication, the Inpatient Pharmacy on call will generally be the one to contact and if it’s an oral medication the ER pharmacist would be the right person. But don’t worry about that too much, the pharmacy staff will get you in touch with the right person. see [[Pharmacy#Inpatient_Pharmacist|Inpatient Pharmacist]] for more details ||24 hours a day, any day
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|-
|Outpatient Pharmacy 1 and 2||The pharmacists logged into these roles are the data entry pharmacists. They can be used to communicate with pharmacy staff regarding prescriptions that have been written, will be written, or to ask pharmacy related questions. see [[Pharmacy#Outpatient_Pharmacist|Outpatient Pharmacist]] for more details. ||8:30am-7:30pm, Monday-Friday (except holidays)
|-
|Village Ops Pharmacist||for pharmacy questions when doing village travel by CHAs, SRC providers, and providers. see [[Pharmacy#Village_Ops_Pharmacist|Village Ops Pharmacist]] for more details. ||8:30am-5:30pm, Monday-Friday (except holidays)
|}

===PROVIDER ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Audiologist On Call|| ||Available Monday-Friday
|-
|Dental on Call|| ||24 hours a day, any day
|-
|Endoscopist On Duty|| ||
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|Family Medicine Resident On Call||to contact the Family Medicine Resident ||24 hours a day, any day (for scheduled shifts)
|-
|Kusko Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Kusko Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|Optometry On Call||For emergency optometry consults||after 5pm weekdays, weekends, and holidays
|-
|Peds Wards on Duty||To communicate about any chronic pediatric patient (CPP) from any village, to consult for any pediatric patient, to summon a pediatrician for an emergency including attendance at a delivery.
'''RMT for any chronic pediatrics patient.'''
||24 hours a day, any day
|-
|Star Doc on-call||If you are the Night Float, use this to call in your back-up doctor for medevacs.||24 hours a day, any day
|-
|Yukon Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Yukon Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|}

===SUPPORT SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|CT Tech on Duty||to communicate any questions regarding CT exams. Also can be used to notify about inbound patients (i.e. ER pending arrivals) but emergent response is probably still best with a phone call (not all staff have TT on their cell phones). ||24 hours a day, any day
|-
|Halibut Hall Registration|| ||
|-
|Hostel|| ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH||to contact Women's Health Case Manager ||
|-
|RN CM on Call for Provider Call Out's|| ||
|-
|Scheduling Department on Call|| ||
|-
|Telehealth On Call Support|| ||
|-
|Travel On Call|| ||
|}

==Groups==
{| class="wikitable"
!NAME OF GROUP!!WHY TO USE IT
|-
|'''Trauma Heads Up'''
||
*This is when we have a trauma coming in that allows us to make sure those that are on call to be on alert. You do not need to call back unless you have questions, this one is just an FYI
*Sender of a heads up message content - needs to enter in basic information, anticipated and ETA. If it gets cancelled please use this notification and “cancel” in message.
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trauma Level I Activation (full trauma activation)'''
||
*This would require all those on the list to come to the ER/or other location if different. Please do not call as this takes time away from staff already dealing with an emergent issue.
*Sender of Trauma level I activation message content – Location, anticipated needs, keep it short and sweet. (you may exclude any one from this list if you are sure you will not need them- example - EX-OR CRNA)
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trama level II Activation (modified trauma)'''
||
*Please send, it allows us to verify activation.
*Sender message – MRN, RM#
#ED Doc,
#RT
#CT Tech
#ED Charge Nurse
|-
|colspan="2"|***Charge nurses will be responsible for making sure the data gets placed in the green folder at the nurses’ station for any Trauma.
|-
|'''OR C-Section'''
||
*To quickly notify staff that would be needed in case of a C-Section
#Peds Wards On Duty
#OR CRNA On Call
#OR Circulating Nurse On Call
#OR Scrub Tech On Call
#RT On Call !!CORRECT!!
#OR Charge Nurse on Call
|}

==Text Duration==
Texts live for 1 day only and then will disappear, so it is not intended for permanent documentation.

Tiger Connect

2023-02-01T03:23:10Z

JenniferH: /* NURSE ROLES */

==Overview==
Tiger Connect has replaced pagers at YKHC. It is automatically installed on your PowerChart/FirstNet desktop and you should also install this on your regular desktop. It can be installed on your personal phone as well.

Tiger Connect allows you to text within YKHC and to ANMC. You can text individuals as well as groups. Roles may be assigned as well and as providers go on/off duty, they will transfer the ‘role’ to the subsequent provider.

==Roles==
Roles may be assigned as well. As providers in these roles go on/off duty, they will transfer the ‘role’ to the on coming provider.

===COVID===
{| class="wikitable" style="width: 90%; margin: auto;"
!NAME OF ROLE!!WHY TO USE IT!!WHEN TO USE IT
|-
|style="width: 25%"|COVID-19 Response Team
|style="width: 50%"|
|style="width: 25%"|24 hours a day, any day
|-
|PPE COVID-19||to communicate need for PPE if not available from department stock||24 hours a day, any day
|-
|Scheduling COVID-19|| ||
|}

===EMERGENCY SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Administrator on-call||To request approval for YK pay for patients who do not meet preapproved criteria. (On nights and weekends, you can use the RMT or ED doctor’s name for urgent travel.)||24 hours a day, any day
|-
|CHAP on Call|| ||
|-
|Child Abuse on Call|| ||24 hours a day, any day
|-
|Clinical Director on-call ||For CD on call issues, and, if you are a hospitalist, to call in sick||24 hours a day, any day
|-
|Clinician Ethicist on-call|| ||24 hours a day, any day
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Ethics Committee On Call|| ||24 hours a day, any day
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|Psych Inpt On Site (not for patients) || ||
|-
|SART Adult On Call|| ||24 hours a day, any day
|-
|SART Peds On Call|| ||24 hours a day, any day
|}

===IT DEPARTMENT===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|IT Manager On Call||Use if you can’t get a hold of a tech via x6070 or TigerConnect, or if you need to escalate ||8am-8pm
|-
|IT Network on Call||For internal use only ||
|-
|IT RAVEN On Call||Use if it is not practical to call and you know it’s a RAVEN issue. ||8am-8pm
|-
|IT Service Desk On Call x6070||Providers should use when it is too urgent for a ticket but not convenient to stay on the line with a tech. (e.g. when they are with a patient)||8am to 8pm
|}

===LONG TERM CARE (LTC)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|LTC (Elders Home) Doc||The physician that staff at LTC should contact when they have medical questions about a LTC resident ||
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|}

===NURSE ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Charge Nurse A/B/C||Any questions about a patient being seen in OPC. Patients who need to be seen via nurse only clinic. Pharmacy TT to see which tube station to send meds to. ||8am-5pm, Monday-Friday (except Holidays)
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|NW Charge Nurse On Duty|| ||24 hours a day, any day
|-
|OB Charge Nurse On Duty||For the providers to alert the charge nurse of patients that are on their way to the unit( from village or clinic), or to ask questions of the charge nurse on duty ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH||to contact Women's Health Case Manager on duty ||
|}

===OPERATING ROOM (OR)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|}

===PHARMACY ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|BH Pharmacy On Call||The pharmacist that staff at our BH residential facilities should contact when they have medication questions || 9am to 10pm, every day
|-
|Clinic A/B/C Pharmacist||to contact the clinic pharmacists that are located in Clinic A, Clinic B, and Clinic C teamrooms. see [[Pharmacy#Clinic_Pharmacist|Clinic Pharmacist]] for more details ||Monday-Friday 8:30am-5:30pm (except holidays)
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Inpatient Pharmacy On Call||to communicate about admitted patients, as well as ER and outpatient patients who need medication from the inpatient pharmacy. There may be some overlap between this role and the ER pharmacist role due to the fact that there is some overlap with regards to where in the building a medication comes from. If it’s an IV medication, the Inpatient Pharmacy on call will generally be the one to contact and if it’s an oral medication the ER pharmacist would be the right person. But don’t worry about that too much, the pharmacy staff will get you in touch with the right person. see [[Pharmacy#Inpatient_Pharmacist|Inpatient Pharmacist]] for more details ||24 hours a day, any day
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|-
|Outpatient Pharmacy 1 and 2||The pharmacists logged into these roles are the data entry pharmacists. They can be used to communicate with pharmacy staff regarding prescriptions that have been written, will be written, or to ask pharmacy related questions. see [[Pharmacy#Outpatient_Pharmacist|Outpatient Pharmacist]] for more details. ||8:30am-7:30pm, Monday-Friday (except holidays)
|-
|Village Ops Pharmacist||for pharmacy questions when doing village travel by CHAs, SRC providers, and providers. see [[Pharmacy#Village_Ops_Pharmacist|Village Ops Pharmacist]] for more details. ||8:30am-5:30pm, Monday-Friday (except holidays)
|}

===PROVIDER ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Audiologist On Call|| ||Available Monday-Friday
|-
|Dental on Call|| ||24 hours a day, any day
|-
|Endoscopist On Duty|| ||
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|Family Medicine Resident On Call|| ||24 hours a day, any day (for scheduled shifts)
|-
|Hooper Bay Provider On Call|| ||
|-
|Kusko Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Kusko Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|Optometry On Call||For emergency optometry consults||after 5pm weekdays, weekends, and holidays
|-
|Peds Wards on Duty||To communicate about any chronic pediatric patient (CPP) from any village, to consult for any pediatric patient, to summon a pediatrician for an emergency including attendance at a delivery.
'''RMT for any chronic pediatrics patient.'''
||24 hours a day, any day
|-
|Star Doc on-call||If you are the Night Float, use this to call in your back-up doctor for medevacs.||24 hours a day, any day
|-
|Yukon Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Yukon Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|}

===SUPPORT SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|CT Tech on Duty||to communicate any questions regarding CT exams. Also can be used to notify about inbound patients (i.e. ER pending arrivals) but emergent response is probably still best with a phone call (not all staff have TT on their cell phones). ||24 hours a day, any day
|-
|Halibut Hall Registration|| ||
|-
|Hostel|| ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH||to contact Women's Health Case Manager ||
|-
|RN CM on Call for Provider Call Out's|| ||
|-
|Scheduling Department on Call|| ||
|-
|Telehealth On Call Support|| ||
|-
|Travel On Call|| ||
|}

==Groups==
{| class="wikitable"
!NAME OF GROUP!!WHY TO USE IT
|-
|'''Trauma Heads Up'''
||
*This is when we have a trauma coming in that allows us to make sure those that are on call to be on alert. You do not need to call back unless you have questions, this one is just an FYI
*Sender of a heads up message content - needs to enter in basic information, anticipated and ETA. If it gets cancelled please use this notification and “cancel” in message.
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trauma Level I Activation (full trauma activation)'''
||
*This would require all those on the list to come to the ER/or other location if different. Please do not call as this takes time away from staff already dealing with an emergent issue.
*Sender of Trauma level I activation message content – Location, anticipated needs, keep it short and sweet. (you may exclude any one from this list if you are sure you will not need them- example - EX-OR CRNA)
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trama level II Activation (modified trauma)'''
||
*Please send, it allows us to verify activation.
*Sender message – MRN, RM#
#ED Doc,
#RT
#CT Tech
#ED Charge Nurse
|-
|colspan="2"|***Charge nurses will be responsible for making sure the data gets placed in the green folder at the nurses’ station for any Trauma.
|-
|'''OR C-Section'''
||
*To quickly notify staff that would be needed in case of a C-Section
#Peds Wards On Duty
#OR CRNA On Call
#OR Circulating Nurse On Call
#OR Scrub Tech On Call
#RT On Call !!CORRECT!!
#OR Charge Nurse on Call
|}

==Text Duration==
Texts live for 1 day only and then will disappear, so it is not intended for permanent documentation.

Tiger Connect

2023-02-01T03:20:39Z

JenniferH: /* EMERGENCY SERVICES */

==Overview==
Tiger Connect has replaced pagers at YKHC. It is automatically installed on your PowerChart/FirstNet desktop and you should also install this on your regular desktop. It can be installed on your personal phone as well.

Tiger Connect allows you to text within YKHC and to ANMC. You can text individuals as well as groups. Roles may be assigned as well and as providers go on/off duty, they will transfer the ‘role’ to the subsequent provider.

==Roles==
Roles may be assigned as well. As providers in these roles go on/off duty, they will transfer the ‘role’ to the on coming provider.

===COVID===
{| class="wikitable" style="width: 90%; margin: auto;"
!NAME OF ROLE!!WHY TO USE IT!!WHEN TO USE IT
|-
|style="width: 25%"|COVID-19 Response Team
|style="width: 50%"|
|style="width: 25%"|24 hours a day, any day
|-
|PPE COVID-19||to communicate need for PPE if not available from department stock||24 hours a day, any day
|-
|Scheduling COVID-19|| ||
|}

===EMERGENCY SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Administrator on-call||To request approval for YK pay for patients who do not meet preapproved criteria. (On nights and weekends, you can use the RMT or ED doctor’s name for urgent travel.)||24 hours a day, any day
|-
|CHAP on Call|| ||
|-
|Child Abuse on Call|| ||24 hours a day, any day
|-
|Clinical Director on-call ||For CD on call issues, and, if you are a hospitalist, to call in sick||24 hours a day, any day
|-
|Clinician Ethicist on-call|| ||24 hours a day, any day
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Ethics Committee On Call|| ||24 hours a day, any day
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|Psych Inpt On Site (not for patients) || ||
|-
|SART Adult On Call|| ||24 hours a day, any day
|-
|SART Peds On Call|| ||24 hours a day, any day
|}

===IT DEPARTMENT===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|IT Manager On Call||Use if you can’t get a hold of a tech via x6070 or TigerConnect, or if you need to escalate ||8am-8pm
|-
|IT Network on Call||For internal use only ||
|-
|IT RAVEN On Call||Use if it is not practical to call and you know it’s a RAVEN issue. ||8am-8pm
|-
|IT Service Desk On Call x6070||Providers should use when it is too urgent for a ticket but not convenient to stay on the line with a tech. (e.g. when they are with a patient)||8am to 8pm
|}

===LONG TERM CARE (LTC)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|LTC (Elders Home) Doc||The physician that staff at LTC should contact when they have medical questions about a LTC resident ||
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|}

===NURSE ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Charge Nurse A/B/C||Any questions about a patient being seen in OPC. Patients who need to be seen via nurse only clinic. Pharmacy TT to see which tube station to send meds to. ||8am-5pm, Monday-Friday (except Holidays)
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|NW Charge Nurse On Duty|| ||24 hours a day, any day
|-
|OB Charge Nurse On Duty||For the providers to alert the charge nurse of patients that are on their way to the unit( from village or clinic), or to ask questions of the charge nurse on duty ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH|| ||
|-
|RN CM on Call for Provider Call Out's|| ||
|}

===OPERATING ROOM (OR)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|}

===PHARMACY ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|BH Pharmacy On Call||The pharmacist that staff at our BH residential facilities should contact when they have medication questions || 9am to 10pm, every day
|-
|Clinic A/B/C Pharmacist||to contact the clinic pharmacists that are located in Clinic A, Clinic B, and Clinic C teamrooms. see [[Pharmacy#Clinic_Pharmacist|Clinic Pharmacist]] for more details ||Monday-Friday 8:30am-5:30pm (except holidays)
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Inpatient Pharmacy On Call||to communicate about admitted patients, as well as ER and outpatient patients who need medication from the inpatient pharmacy. There may be some overlap between this role and the ER pharmacist role due to the fact that there is some overlap with regards to where in the building a medication comes from. If it’s an IV medication, the Inpatient Pharmacy on call will generally be the one to contact and if it’s an oral medication the ER pharmacist would be the right person. But don’t worry about that too much, the pharmacy staff will get you in touch with the right person. see [[Pharmacy#Inpatient_Pharmacist|Inpatient Pharmacist]] for more details ||24 hours a day, any day
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|-
|Outpatient Pharmacy 1 and 2||The pharmacists logged into these roles are the data entry pharmacists. They can be used to communicate with pharmacy staff regarding prescriptions that have been written, will be written, or to ask pharmacy related questions. see [[Pharmacy#Outpatient_Pharmacist|Outpatient Pharmacist]] for more details. ||8:30am-7:30pm, Monday-Friday (except holidays)
|-
|Village Ops Pharmacist||for pharmacy questions when doing village travel by CHAs, SRC providers, and providers. see [[Pharmacy#Village_Ops_Pharmacist|Village Ops Pharmacist]] for more details. ||8:30am-5:30pm, Monday-Friday (except holidays)
|}

===PROVIDER ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Audiologist On Call|| ||Available Monday-Friday
|-
|Dental on Call|| ||24 hours a day, any day
|-
|Endoscopist On Duty|| ||
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|Family Medicine Resident On Call|| ||24 hours a day, any day (for scheduled shifts)
|-
|Hooper Bay Provider On Call|| ||
|-
|Kusko Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Kusko Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|Optometry On Call||For emergency optometry consults||after 5pm weekdays, weekends, and holidays
|-
|Peds Wards on Duty||To communicate about any chronic pediatric patient (CPP) from any village, to consult for any pediatric patient, to summon a pediatrician for an emergency including attendance at a delivery.
'''RMT for any chronic pediatrics patient.'''
||24 hours a day, any day
|-
|Star Doc on-call||If you are the Night Float, use this to call in your back-up doctor for medevacs.||24 hours a day, any day
|-
|Yukon Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Yukon Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|}

===SUPPORT SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|CT Tech on Duty||to communicate any questions regarding CT exams. Also can be used to notify about inbound patients (i.e. ER pending arrivals) but emergent response is probably still best with a phone call (not all staff have TT on their cell phones). ||24 hours a day, any day
|-
|Halibut Hall Registration|| ||
|-
|Hostel|| ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH||to contact Women's Health Case Manager ||
|-
|RN CM on Call for Provider Call Out's|| ||
|-
|Scheduling Department on Call|| ||
|-
|Telehealth On Call Support|| ||
|-
|Travel On Call|| ||
|}

==Groups==
{| class="wikitable"
!NAME OF GROUP!!WHY TO USE IT
|-
|'''Trauma Heads Up'''
||
*This is when we have a trauma coming in that allows us to make sure those that are on call to be on alert. You do not need to call back unless you have questions, this one is just an FYI
*Sender of a heads up message content - needs to enter in basic information, anticipated and ETA. If it gets cancelled please use this notification and “cancel” in message.
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trauma Level I Activation (full trauma activation)'''
||
*This would require all those on the list to come to the ER/or other location if different. Please do not call as this takes time away from staff already dealing with an emergent issue.
*Sender of Trauma level I activation message content – Location, anticipated needs, keep it short and sweet. (you may exclude any one from this list if you are sure you will not need them- example - EX-OR CRNA)
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trama level II Activation (modified trauma)'''
||
*Please send, it allows us to verify activation.
*Sender message – MRN, RM#
#ED Doc,
#RT
#CT Tech
#ED Charge Nurse
|-
|colspan="2"|***Charge nurses will be responsible for making sure the data gets placed in the green folder at the nurses’ station for any Trauma.
|-
|'''OR C-Section'''
||
*To quickly notify staff that would be needed in case of a C-Section
#Peds Wards On Duty
#OR CRNA On Call
#OR Circulating Nurse On Call
#OR Scrub Tech On Call
#RT On Call !!CORRECT!!
#OR Charge Nurse on Call
|}

==Text Duration==
Texts live for 1 day only and then will disappear, so it is not intended for permanent documentation.

Tiger Connect

2023-02-01T03:16:44Z

JenniferH: /* PHARMACY ROLES */

==Overview==
Tiger Connect has replaced pagers at YKHC. It is automatically installed on your PowerChart/FirstNet desktop and you should also install this on your regular desktop. It can be installed on your personal phone as well.

Tiger Connect allows you to text within YKHC and to ANMC. You can text individuals as well as groups. Roles may be assigned as well and as providers go on/off duty, they will transfer the ‘role’ to the subsequent provider.

==Roles==
Roles may be assigned as well. As providers in these roles go on/off duty, they will transfer the ‘role’ to the on coming provider.

===COVID===
{| class="wikitable" style="width: 90%; margin: auto;"
!NAME OF ROLE!!WHY TO USE IT!!WHEN TO USE IT
|-
|style="width: 25%"|COVID-19 Response Team
|style="width: 50%"|
|style="width: 25%"|24 hours a day, any day
|-
|PPE COVID-19||to communicate need for PPE if not available from department stock||24 hours a day, any day
|-
|Scheduling COVID-19|| ||
|}

===EMERGENCY SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Administrator on-call||To request approval for YK pay for patients who do not meet preapproved criteria. (On nights and weekends, you can use the RMT or ED doctor’s name for urgent travel.)||24 hours a day, any day
|-
|CHAP on Call|| ||
|-
|Child Abuse on Call|| ||24 hours a day, any day
|-
|Clinical Director on-call ||For CD on call issues, and, if you are a hospitalist, to call in sick||24 hours a day, any day
|-
|Clinician Ethicist on-call|| ||24 hours a day, any day
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Ethics Committee On Call|| ||24 hours a day, any day
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|Psych On Call|| ||
|-
|SART Adult On Call|| ||24 hours a day, any day
|-
|SART Peds On Call|| ||24 hours a day, any day
|}

===IT DEPARTMENT===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|IT Manager On Call||Use if you can’t get a hold of a tech via x6070 or TigerConnect, or if you need to escalate ||8am-8pm
|-
|IT Network on Call||For internal use only ||
|-
|IT RAVEN On Call||Use if it is not practical to call and you know it’s a RAVEN issue. ||8am-8pm
|-
|IT Service Desk On Call x6070||Providers should use when it is too urgent for a ticket but not convenient to stay on the line with a tech. (e.g. when they are with a patient)||8am to 8pm
|}

===LONG TERM CARE (LTC)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|LTC (Elders Home) Doc||The physician that staff at LTC should contact when they have medical questions about a LTC resident ||
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|}

===NURSE ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Charge Nurse A/B/C||Any questions about a patient being seen in OPC. Patients who need to be seen via nurse only clinic. Pharmacy TT to see which tube station to send meds to. ||8am-5pm, Monday-Friday (except Holidays)
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|NW Charge Nurse On Duty|| ||24 hours a day, any day
|-
|OB Charge Nurse On Duty||For the providers to alert the charge nurse of patients that are on their way to the unit( from village or clinic), or to ask questions of the charge nurse on duty ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH|| ||
|-
|RN CM on Call for Provider Call Out's|| ||
|}

===OPERATING ROOM (OR)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|}

===PHARMACY ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|BH Pharmacy On Call||The pharmacist that staff at our BH residential facilities should contact when they have medication questions || 9am to 10pm, every day
|-
|Clinic A/B/C Pharmacist||to contact the clinic pharmacists that are located in Clinic A, Clinic B, and Clinic C teamrooms. see [[Pharmacy#Clinic_Pharmacist|Clinic Pharmacist]] for more details ||Monday-Friday 8:30am-5:30pm (except holidays)
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Inpatient Pharmacy On Call||to communicate about admitted patients, as well as ER and outpatient patients who need medication from the inpatient pharmacy. There may be some overlap between this role and the ER pharmacist role due to the fact that there is some overlap with regards to where in the building a medication comes from. If it’s an IV medication, the Inpatient Pharmacy on call will generally be the one to contact and if it’s an oral medication the ER pharmacist would be the right person. But don’t worry about that too much, the pharmacy staff will get you in touch with the right person. see [[Pharmacy#Inpatient_Pharmacist|Inpatient Pharmacist]] for more details ||24 hours a day, any day
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|-
|Outpatient Pharmacy 1 and 2||The pharmacists logged into these roles are the data entry pharmacists. They can be used to communicate with pharmacy staff regarding prescriptions that have been written, will be written, or to ask pharmacy related questions. see [[Pharmacy#Outpatient_Pharmacist|Outpatient Pharmacist]] for more details. ||8:30am-7:30pm, Monday-Friday (except holidays)
|-
|Village Ops Pharmacist||for pharmacy questions when doing village travel by CHAs, SRC providers, and providers. see [[Pharmacy#Village_Ops_Pharmacist|Village Ops Pharmacist]] for more details. ||8:30am-5:30pm, Monday-Friday (except holidays)
|}

===PROVIDER ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Audiologist On Call|| ||Available Monday-Friday
|-
|Dental on Call|| ||24 hours a day, any day
|-
|Endoscopist On Duty|| ||
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|Family Medicine Resident On Call|| ||24 hours a day, any day (for scheduled shifts)
|-
|Hooper Bay Provider On Call|| ||
|-
|Kusko Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Kusko Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|Optometry On Call||For emergency optometry consults||after 5pm weekdays, weekends, and holidays
|-
|Peds Wards on Duty||To communicate about any chronic pediatric patient (CPP) from any village, to consult for any pediatric patient, to summon a pediatrician for an emergency including attendance at a delivery.
'''RMT for any chronic pediatrics patient.'''
||24 hours a day, any day
|-
|Star Doc on-call||If you are the Night Float, use this to call in your back-up doctor for medevacs.||24 hours a day, any day
|-
|Yukon Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Yukon Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|}

===SUPPORT SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|CT Tech on Duty||to communicate any questions regarding CT exams. Also can be used to notify about inbound patients (i.e. ER pending arrivals) but emergent response is probably still best with a phone call (not all staff have TT on their cell phones). ||24 hours a day, any day
|-
|Halibut Hall Registration|| ||
|-
|Hostel|| ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH||to contact Women's Health Case Manager ||
|-
|RN CM on Call for Provider Call Out's|| ||
|-
|Scheduling Department on Call|| ||
|-
|Telehealth On Call Support|| ||
|-
|Travel On Call|| ||
|}

==Groups==
{| class="wikitable"
!NAME OF GROUP!!WHY TO USE IT
|-
|'''Trauma Heads Up'''
||
*This is when we have a trauma coming in that allows us to make sure those that are on call to be on alert. You do not need to call back unless you have questions, this one is just an FYI
*Sender of a heads up message content - needs to enter in basic information, anticipated and ETA. If it gets cancelled please use this notification and “cancel” in message.
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trauma Level I Activation (full trauma activation)'''
||
*This would require all those on the list to come to the ER/or other location if different. Please do not call as this takes time away from staff already dealing with an emergent issue.
*Sender of Trauma level I activation message content – Location, anticipated needs, keep it short and sweet. (you may exclude any one from this list if you are sure you will not need them- example - EX-OR CRNA)
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trama level II Activation (modified trauma)'''
||
*Please send, it allows us to verify activation.
*Sender message – MRN, RM#
#ED Doc,
#RT
#CT Tech
#ED Charge Nurse
|-
|colspan="2"|***Charge nurses will be responsible for making sure the data gets placed in the green folder at the nurses’ station for any Trauma.
|-
|'''OR C-Section'''
||
*To quickly notify staff that would be needed in case of a C-Section
#Peds Wards On Duty
#OR CRNA On Call
#OR Circulating Nurse On Call
#OR Scrub Tech On Call
#RT On Call !!CORRECT!!
#OR Charge Nurse on Call
|}

==Text Duration==
Texts live for 1 day only and then will disappear, so it is not intended for permanent documentation.

Tiger Connect

2023-02-01T02:58:56Z

JenniferH: /* Roles */

==Overview==
Tiger Connect has replaced pagers at YKHC. It is automatically installed on your PowerChart/FirstNet desktop and you should also install this on your regular desktop. It can be installed on your personal phone as well.

Tiger Connect allows you to text within YKHC and to ANMC. You can text individuals as well as groups. Roles may be assigned as well and as providers go on/off duty, they will transfer the ‘role’ to the subsequent provider.

==Roles==
Roles may be assigned as well. As providers in these roles go on/off duty, they will transfer the ‘role’ to the on coming provider.

===COVID===
{| class="wikitable" style="width: 90%; margin: auto;"
!NAME OF ROLE!!WHY TO USE IT!!WHEN TO USE IT
|-
|style="width: 25%"|COVID-19 Response Team
|style="width: 50%"|
|style="width: 25%"|24 hours a day, any day
|-
|PPE COVID-19||to communicate need for PPE if not available from department stock||24 hours a day, any day
|-
|Scheduling COVID-19|| ||
|}

===EMERGENCY SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Administrator on-call||To request approval for YK pay for patients who do not meet preapproved criteria. (On nights and weekends, you can use the RMT or ED doctor’s name for urgent travel.)||24 hours a day, any day
|-
|CHAP on Call|| ||
|-
|Child Abuse on Call|| ||24 hours a day, any day
|-
|Clinical Director on-call ||For CD on call issues, and, if you are a hospitalist, to call in sick||24 hours a day, any day
|-
|Clinician Ethicist on-call|| ||24 hours a day, any day
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Ethics Committee On Call|| ||24 hours a day, any day
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|Psych On Call|| ||
|-
|SART Adult On Call|| ||24 hours a day, any day
|-
|SART Peds On Call|| ||24 hours a day, any day
|}

===IT DEPARTMENT===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|IT Manager On Call||Use if you can’t get a hold of a tech via x6070 or TigerConnect, or if you need to escalate ||8am-8pm
|-
|IT Network on Call||For internal use only ||
|-
|IT RAVEN On Call||Use if it is not practical to call and you know it’s a RAVEN issue. ||8am-8pm
|-
|IT Service Desk On Call x6070||Providers should use when it is too urgent for a ticket but not convenient to stay on the line with a tech. (e.g. when they are with a patient)||8am to 8pm
|}

===LONG TERM CARE (LTC)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|LTC (Elders Home) Doc||The physician that staff at LTC should contact when they have medical questions about a LTC resident ||
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|}

===NURSE ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Charge Nurse A/B/C||Any questions about a patient being seen in OPC. Patients who need to be seen via nurse only clinic. Pharmacy TT to see which tube station to send meds to. ||8am-5pm, Monday-Friday (except Holidays)
|-
|ED Charge Nurse On Duty|| ||24 hours a day, any day
|-
|NW Charge Nurse On Duty|| ||24 hours a day, any day
|-
|OB Charge Nurse On Duty||For the providers to alert the charge nurse of patients that are on their way to the unit( from village or clinic), or to ask questions of the charge nurse on duty ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH|| ||
|-
|RN CM on Call for Provider Call Out's|| ||
|}

===OPERATING ROOM (OR)===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|OR CRNA On Call||for help with difficult airway or intubation OR general anesthesia needs with C-section or other emergency procedures, part of OR STAT C-section group||24 hours a day, any day
|-
|OR Charge Nurse On Call||to schedule an OR case after discussing it with anesthesia ||24 hours a day, any day
|-
|OR Circulating Nurse On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|-
|OR Scrub Tech On Call||texted as part of OR STAT C-section group||24 hours a day, any day
|}

===PHARMACY ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|BH Pharmacy On Call||The pharmacist that staff at our BH residential facilities should contact when they have medication questions || 9am to 10pm, every day
|-
|Clinic A/B/C Pharmacist||to contact the clinic pharmacists that are located in Clinic A, Clinic B, and Clinic C teamrooms ||Monday-Friday 8:30am-5:30pm (except holidays)
|-
|ER Pharmacist||to answer questions from the ER about prescriptions ||9am-10pm, Monday-Friday (except holidays)
|-
|Inpatient Pharmacy On Call||to communicate about admitted patients, as well as ER and outpatient patients who need medication from the inpatient pharmacy. There may be some overlap between this role and the ER pharmacist role due to the fact that there is some overlap with regards to where in the building a medication comes from. If it’s an IV medication, the Inpatient Pharmacy on call will generally be the one to contact and if it’s an oral medication the ER pharmacist would be the right person. But don’t worry about that too much, the pharmacy staff will get you in touch with the right person. ||24 hours a day, any day
|-
|LTC Pharmacy On Call||The pharmacist that staff at LTC should contact when they have medication questions (including needing refills of PRN medications and questions about items on the MAR)||9am-10pm, every day
|-
|Outpatient Pharmacy 1 and 2||The pharmacists logged into these roles are the data entry pharmacists. They can be used to communicate with pharmacy staff regarding prescriptions that have been written, will be written, or to ask pharmacy related questions. ||8:30am-7:30pm, Monday-Friday (except holidays)
|-
|Village Ops Pharmacist||for pharmacy questions when doing village travel by CHAs, SRC providers, and providers. ||8:30am-5:30pm, Monday-Friday (except holidays)
|}

===PROVIDER ROLES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|Audiologist On Call|| ||Available Monday-Friday
|-
|Dental on Call|| ||24 hours a day, any day
|-
|Endoscopist On Duty|| ||
|-
|ED doctor on duty||To communicate about a patient for whom a medevac is already activated. (Usually better to just call the main ED number and ask to speak to the ED doc). To communicate about a patient who needs to be transferred to the ED, '''NOT''' EMERGENCY RMT (unless patient is already being medevac’d)||24 hours a day, any day
|-
|Family Medicine Resident On Call|| ||24 hours a day, any day (for scheduled shifts)
|-
|Hooper Bay Provider On Call|| ||
|-
|Kusko Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Kusko Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|-
|OB High Risk On Call HROB||To communicate about patients with pregnancy-related complications.||24 hours a day, any day
|-
|Optometry On Call||For emergency optometry consults||after 5pm weekdays, weekends, and holidays
|-
|Peds Wards on Duty||To communicate about any chronic pediatric patient (CPP) from any village, to consult for any pediatric patient, to summon a pediatrician for an emergency including attendance at a delivery.
'''RMT for any chronic pediatrics patient.'''
||24 hours a day, any day
|-
|Star Doc on-call||If you are the Night Float, use this to call in your back-up doctor for medevacs.||24 hours a day, any day
|-
|Yukon Wards Doctor (Emergency RMT)||To communicate to the wards doctor about patients from Yukon Villages, including '''FOR EMERGENCY RMT'''.
For SRC providers, emergency consultation with physician.
||Every day 8a-6p (even holidays and weekends)
|}

===SUPPORT SERVICES===
{| class="wikitable" style="width: 90%; margin: auto;"
!style="width: 25%"|NAME OF ROLE!!style="width: 50%"|WHY TO USE IT!!style="width: 25%"|WHEN TO USE IT
|-
|CT Tech on Duty||to communicate any questions regarding CT exams. Also can be used to notify about inbound patients (i.e. ER pending arrivals) but emergent response is probably still best with a phone call (not all staff have TT on their cell phones). ||24 hours a day, any day
|-
|Halibut Hall Registration|| ||
|-
|Hostel|| ||24 hours a day, any day
|-
|RN CM On Call-Peds|| ||
|-
|RN CM On Call - Family Med|| ||
|-
|RN CM on Call - WH||to contact Women's Health Case Manager ||
|-
|RN CM on Call for Provider Call Out's|| ||
|-
|Scheduling Department on Call|| ||
|-
|Telehealth On Call Support|| ||
|-
|Travel On Call|| ||
|}

==Groups==
{| class="wikitable"
!NAME OF GROUP!!WHY TO USE IT
|-
|'''Trauma Heads Up'''
||
*This is when we have a trauma coming in that allows us to make sure those that are on call to be on alert. You do not need to call back unless you have questions, this one is just an FYI
*Sender of a heads up message content - needs to enter in basic information, anticipated and ETA. If it gets cancelled please use this notification and “cancel” in message.
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trauma Level I Activation (full trauma activation)'''
||
*This would require all those on the list to come to the ER/or other location if different. Please do not call as this takes time away from staff already dealing with an emergent issue.
*Sender of Trauma level I activation message content – Location, anticipated needs, keep it short and sweet. (you may exclude any one from this list if you are sure you will not need them- example - EX-OR CRNA)
#Pharmacy
#OR CRNA
#ED Charge Nurse
#ED Doctor
#RT
#CT Tech
#Lab
|-
|'''Trama level II Activation (modified trauma)'''
||
*Please send, it allows us to verify activation.
*Sender message – MRN, RM#
#ED Doc,
#RT
#CT Tech
#ED Charge Nurse
|-
|colspan="2"|***Charge nurses will be responsible for making sure the data gets placed in the green folder at the nurses’ station for any Trauma.
|-
|'''OR C-Section'''
||
*To quickly notify staff that would be needed in case of a C-Section
#Peds Wards On Duty
#OR CRNA On Call
#OR Circulating Nurse On Call
#OR Scrub Tech On Call
#RT On Call !!CORRECT!!
#OR Charge Nurse on Call
|}

==Text Duration==
Texts live for 1 day only and then will disappear, so it is not intended for permanent documentation.

Tiger Connect

2023-02-01T02:51:55Z

JenniferH: /* Roles */

Category:Behavioral Health

2023-02-01T02:43:57Z

JenniferH: /* YKHC Psychiatric Resources */

==OVERVIEW==
We have a very at risk population for suicide and substance abuse. We have a very high suicide rate. We screen for depression on every visit, and contact the ACT clinician for a positive screen. If the depression screen is positive during the screening for an outpatient visit in the SRCs, the Wellness Counselor or Behavioral Health clinician in the SRC should be called to see the patient. Below is a list of the different resources available in the different parts of the hospital for our patients.

The service delivery system at YKHC is comprised of various service components, including Crisis Services, Outpatient and Village Services, Residential Services, Developmental Disabilities, and Support Services.

===Alcohol/Drug Use In The Delta===
Alcohol and drug use, like the rest of the country, is problematic in the YK Delta. At this time, Bethel is a “damp” community, which means alcohol is not sold here, but it can be brought in.

Marijuana use is very common, and recreational use is legal in Alaska. Per Alaska state law, every person is allowed to grow 4 plants and have product for personal use. They are not allowed to transport, smoke in public, or sell it to others. There are two marijuana retail shops in Bethel. People can get marijuana cards from providers in Anchorage, '''''but YKHC is not allowed to give medical marijuana cards or prescribe marijuana as we are a federal facility. The exception is for Marinol.'''''

We also are having an influx of heroin in the Bethel area and the villages, which has resulted in deaths due to overdose. Use seems to be mainly smoking, but there is also some injection use. Naloxone is available in the Village Clinics and can be prescribed for patients on chronic narcotic therapy.

Prescription medication abuse is also present and YKHC works hard to combat this with our '''Pain Management Program and Pain Committee'''. For patients seeking treatment for opioid dependence, contact the Opioid Treatment Case Manager.

Options for patients interested in getting treatment for substance abuse include a Bethel alcohol treatment facility (i.e., The Healing Center) and multiple treatment facilities in Anchorage, Juneau, and Sitka. The best way to get our patients into treatment is to either refer them to YKHC Behavioral Health through PowerChart/FirstNet or call 543-6161 to help get them set up for an assessment. For patients with private insurance, you can call Bethel Family Clinic to help facilitate setting up treatment plans.

Several AA/NA groups and Al anon meet in town weekly at the Catholic Church, The Healing Center, Tundra Women’s Coalition, and the Hospital Main Conference Room.

==Behavioral Health Crisis Services ==
Crisis Services will respond to urgent behavioral health services needs that occur in the Bethel hospital and regional clinics. Urgent behavioral health services needs include responding to Title 47 requests for mental health status evaluations to determine what level of care a patient will need to alleviate an urgent behavioral health crisis. Urgent care walk-in times and primary care consultation services are also provided.

===Emergency Services ===
Emergency Services conducts behavioral health evaluations of individuals who present as being in crisis and to take appropriate steps to initiate the provision of services depending on the outcome of the evaluation. They will assist monitoring of patients in the hospital on Northwing who are involuntarily held for Title 47-related observation and evaluation for further treatment or referral.

Village Services directly administers the Emergency Services component. Emergency On-Call Responders-Emergency Services Clinicians and Complex Care Managers are available twenty-four hours per day to respond to behavioral health crisis for all individuals in the Yukon-Kuskokwim service area. The responders provide immediate mental status examinations and work with the primary care providers in the village or hospital to plan care for management of the crisis and follow-up of the individual. On-Call Attendants are available to stay with an individual admitted to the hospital for evaluation when ordered by an admitting physician to provide safety and security for a client. During the evaluation period comprehensive mental health and substance abuse assessments are completed by the Emergency Services Clinician to assess and manage the client within the behavioral health system of care. '''The Emergency On-Call Response Team is available twenty-four hours per day at 543-6100 or 1-800-478-2642'''

If you have an actively suicidal patient in a village, the VPOs or state troopers will need to be involved and the patient will have to be escorted from the village on a Title 47 with a police escort. There is always an on-call Behavioral Health Clinician in Bethel who is available by Tiger Connect. He/she can help make the arrangements for the Title 47 with the VPOs and make sure that the patient goes straight to the ER when they arrive in Bethel.

===Inpatient Psychiatric Services===
We have four observation rooms where psychiatric patients (suicidal/homicidal ideations, overdoses, acute psychosis) can be admitted.

There is a psychiatric service for ED and inpatient which is staffed by Psychiatrists, Psychiatric NPs, and Psychiatric PAs. They can be reached via Tiger Connect to ‘Psych On-Call’. They may also be involved in following-up, typically via VTC or Telehealth with recently discharged patients.

Patients may also be transported to the Alaska Psychiatric Institute (API) or North Star Behavioral Health in Anchorage.

=== Crisis Incident Stress Debriefing ===
Coordinate Critical Incident Stress Debriefings (CISD) response teams with other providers throughout the YK –Delta and debrief with trauma first responders. Develops Crisis intervention teams with community partners throughout the YK-Delta. Coordinates the training and certification of the crisis team members. Coordinates all logistics of crisis village-based responses by contacting and deploying team members and ensuring adequate coverage and follow-up.

==Behavioral Health Outpatient Resources==
=== YKHC Psychiatric Resources===
David Ondich, MD is our adult psychiatrist who prescribes most of the psychiatric medication needed in the Delta. He sees patients via VTC in the Behavioral Health Department in Bethel. He is available by email at David_Ondich@ykhc.org.

=== YKHC Psychological Resources===
The Yukon-Kuskokwim Health Corporation employs one Licensed Clinical Psychologist who provides psychometrics and interpretive reports to assist in the provision of comprehensive diagnostics to specific clients in the region.

=== Children’s Specialty Diagnostic Services ===
Children’s Specialty Diagnostic Services provide two mental health professional clinicians who work directly with children to ensure appropriate diagnosis particularly when multiple contributing factors (including abuse issues, FAS/FAE) must be considered.

=== YKHC Outpatient Counseling Services ===
Outpatient Counseling Services are available in the regional clinic as well to supplement services especially to Bethel residents, when a close relative may be the village counselor, and for the villages who may not yet have a counselor. Services available in the villages include: substance abuse assessments; individual, couple and family counseling; substance abuse outpatient and aftercare counseling; anger management sessions; substance abuse treatment groups and other specialty groups are available. These same services are all available through outpatient counseling services in Bethel.

Village Clinicians are Master’s level prepared in Human Services with both experience and specialized training in the fields of Mental Health and Substance Abuse Treatment. They receive culturally appropriate training in supervision of native counselors and work closely with the Village Behavioral Health Aides (BHAs), clients, family and other providers to complete a holistic intake and develop treatment plans for implementation by the village based service providers. This service employs five full time staff members. BHA’s are positioned at many villages to engage community services and make referrals for higher levels of care, as needed.

===YKHC Outpatient ACT Program===
At the Ambulatory Outpatient Clinics in Bethel, there are Outpatient Behavioral Health Clinicians, who work with the '''Access to Collaborative Treatment or ACT program'''. All patients over the age of 16 are offered the PHQ-9 depression screening questionnaire. Please review it briefly when seeing the patient. If they score =>15, or they check the questionnaire saying they think about dying, or they need a real time intervention, call ext. 6553 and one of the ACT clinicians will respond. A referral to ACT can also be made via PowerChart/FirstNet. They are available during the day to counsel patients about depression, anxiety, relaxation exercises, grief, etc. If the ACT clinician feels they need a few more sessions, the ACT clinician can set up appointments with the patient. If he/she feels the patient needs more extensive counseling, he/she can facilitate an appointment with a counselor from the main Behavioral Health Department.

===YKHC Behavioral Health Department===
The YKHC Behavioral Health Department is on the second floor of the hospital. There are several family and child counselors. They also supervise the Behavioral Health Clinicians and the Behavioral Health Aides that work in the SRC facilities.

===Non-YKHC Behavioral Health in Bethel===
Patients may choose behavioral health services outside of YKHC, which would be the financial responsibility of the patient. The Bethel Family Clinic has behavioral health services, including narcotic addiction. Bethel Family Clinic is the local Health Resources and Services Administration (HRSA) clinic and uses a sliding scale fee.

==SRC Outpatient Behavioral Health Resources==
At each SRC there should be at least one Wellness Counselor, a Behavioral Health Aide, who can counsel and listen to patients who have anxiety or depression.

== Prevention Services ==
Prevention services, established in January 2012, has established traditional healing and elder consultation as the forums with which to implement community and family support systems in the region’s villages.

===Family Spirit Program — Calricaraq===
Grew out of a collaborative effort of the communities of the Yukon-Kuskokwim region, the Department of Health and Social Services, Division of Alcohol and Drug Abuse, Office of Children Services, the YKHC, Association of Village Council Presidents (AVCP), Tundra Women’s Center (TWC), Orutsararmuit Native Council (ONC) and other community providers in the Yukon-Kuskokwim Delta area. The primary purpose of the project is to implement a community development model that strengthens families, using collaborative efforts of regional resources with local resources and traditional family life and values. The primary goal of the program is for children to be safer in their homes.

===Meth and Suicide Prevention Initiative (MSPI)===
This is a program that utilizes the Family Spirit model to provide community support, education and training on the issues related to suicide at villages. This program has two full time staff to coordinate MSPI activities.

===SBIRT===
(Screening Brief Intervention Referral to Treatment) program is an evidence-based program for planning, organizing, and coordinating alcohol abuse screening activities with all YKHC patient care areas to screen and refer primary care patients to substance abuse treatment, as needed. SBIRT tracks progress SBIRT screenings, referrals made, and referrals completed.

===Sobering Center===
Was created to divert inebriates from the emergency room and jail to a more adequate and safe place to sober up. It utilizes three full time ER technicians and a manager who is responsible for Sobering Center program design, development, management, quality assurance, and evaluation and reporting

== Residential Services ==

=== Crisis Respite Center (CRC) ===
CRC is a five-bed program that provides emergency support services for individuals experiencing a life crisis so disruptive it cannot be managed in an outpatient setting. CRC provides evaluation, treatment, psychosocial rehabilitation, cultural activities, and referral in a voluntary setting for those individuals needing to be monitored and protected, or those just needing some temporary help. CRC works closely with the Alaska Psychiatric Institute (State Hospital), Emergency Services, Integrated Outpatient clinic and other residential programs. The alternative setting provided by the Crisis Respite Center, while ensuring the client's needs are met closer to their home community, can also ensure the client’s needs are met in a culturally sensitive manner.

=== Bautisa House ===
Bautisa House is a home for adults in the region with a severe and persistent mental illness. It is a 10-bed licensed assisted living home. The program serves older and/or more disabled individuals and offers long-term place. Some residents also have a developmental disability. The program teaches them daily living job-seeking and independent living skills as appropriate, and provides access to cultural and community activities.

=== Malone Home ===
Malone Home is a 5-bed assisted living home for adults with moderate to severe mental retardation. The team members work closely with DD services to provide appropriate services and habilitation to the residents. The home provides a long term setting for those that live there.

=== Phillips Ayagnirvik Treatment Center (PATC) ===
The PATC offers a ―new beginning to individuals suffering from the disease of substance abuse or addiction. PATC offers a full continuum of care, including Residential Treatment, Outpatient, Aftercare, and a Therapeutic Court Treatment Program. The PATC Recovery Program regional and statewide referrals with treatment modalities, which combine 12 Step Recovery with research-based treatment methods, and build upon cultural teachings by Elders, and medical or psychiatric services for patient who need them. Positive Native Family Values, Life Skills and Anger Management classes are an integral part of the Treatment Program. Traditional crafts and Subsistence activities are a valuable addition to our services.

=== Residential Program ===
PATC operates a ASAM Level III.5 treatment facility with 16 beds for both men and women. We have an ―open enrollment models, with an average 6-week length of stay. ‖ The Program is fully capable of treating co-occuring mental health issues along with all kinds of substance abuse and addiction.

=== McCann Treatment Center ===
McCann Treatment Center is a 14-bed facility that houses two programs for male youth ages 10 – 18. The youth from both programs work together with team members to develop their strengths, learn skills to live at home, and reduce symptoms of emotional disturbance and substance abuse. A key component of McCann is a strong culturally relevant subsistence program. Youth are involved in year round subsistence activities, including winter trapping, summer fishing, fall berry picking and spring ice fishing.

==== Residential Psychiatric Treatment Center ====
The McCann Treatment Center (MTC) is a culturally diverse, individualized, strengthens based program that focused on building self-value and meeting the clients’ needs using an eclectic and comprehensive approach to treatment. As a Residential Psychiatric Treatment (RPTC), with a focus on inhalant and substance abuse, treatment includes complete assessments; individual/group/family psychotherapy; psycho-educational groups on multiple topics; recreational and cultural activities; an accredited school with two certified teachers, comprehensive Subsistence Education Program; and life skills training to help each youth gain confidence and self-value. Our state of the art building has a gym for exercise and therapeutic games, a special Men’s House for activities with elders and families, and a steam to relax and process with elders and staff.

====Behavior Rehabilitation Services (BRS) program====
Eight beds are available for youth placed in the Behavior Rehabilitation Services (BRS) program. The BRS program services clients that are in the custodial care of the Office of Children’s Services (OCS) or the Department of Juvenile Justice (DJJ). Six beds are available for RPTC or Community Referrals. Clients referred to the PRTC beds, as well as the BRS beds, join together in the treatment process and form a therapeutic community. Length of stay is 12-18 months for both the RPTC and Boys Group Home program.

==Learning Resource Center==
The Learning Resource Center is a day habilitation program for open to all our residential and community consumers. Psychosocial rehabilitation, skills building, groups, and cultural activities are the focus of the program.

== Outpatient Programs ==
Phillips Ayagnirvik (PATC) offers two outpatient components. These are both ASAM Level I. Aftercare is offered for those who have completed residential treatment and can access services in Bethel. Outpatient services are provided for those consumers who do not require a residential level of care.

==Resources/References==
* [[Media:Posttraumatic Stress Disorder 12-11-2018.pdf| Posttraumatic Stress Disorder (PTSD) 2018)]] (PowerPoint Presentation)
* [[media:Psychological Evaluation YK.pdf|Psychological Evaluation for YK Delta Residents 2018]] (PowerPoint Presentation)
* [[media:Psychiatric Vignettes.pdf|Vignettes Illustrating Special Psychiatric Populations 2017]] (PowerPoint Presentation)

Tiger Connect

2023-02-01T02:41:55Z

JenniferH: /* Roles */

Tiger Connect

2023-02-01T02:36:43Z

JenniferH: /* Roles */

Tiger Connect

2023-02-01T02:28:43Z

JenniferH: /* Roles */

Tiger Connect

2023-02-01T02:22:13Z

JenniferH: /* Roles */

Pharmacy

2023-02-01T02:04:54Z

JenniferH: /* Clinic Pharmacist */

'''Pharmacy verifies every order and presciption you place. They often catch mistakes. Please, be nice to them when they call you! '''

==Introduction==

Our pharmacists are a great resource. Always feel free to ask the pharmacists questions. They are always willing to look up things.

We do have a limited formulary and all formulary items are designated with a green circle, a yellow triangle, or a red square in PowerChart/FirstNet.
[[file:Pharmacy_Indicators.png|center|800px]]
These symbols cannot be seen within the Dynamic Documentation workflows however, if medications are selected from PowerPlans or folders, they will be on formulary. The pharmacists will call you if you order something not on the formulary. If you want to order a non-formulary item you can use a Non-Formulary Request form and the pharmacist will determine if the non-formulary item is allowed.

Pharmacy also manages Coumadin patients and does their INRs in the pharmacy in Bethel or village clinic coordinating with the local Health Aide.

Outpatient pharmacists are also available for comprehensive medication review, dosing consultations, pain management, poly-pharmacy review for elders, and prior authorizations.

==Pharmacy Roles==
===Clinic Pharmacist===
*Monday-Friday 8:30am-5:30pm, closed holidays
*Clinic A, B, and C pharmacist roles are available in tigertext
Clinic pharmacists are physically located in the ambulatory clinics and are readily available to help answer medication related questions for providers and patients. One of their main responsibilities is to manage the thousands of refill requests that come through the pharmacy each month. A clinic pharmacist receives the refill requests, evaluates whether the patient and their prescription meet the criteria defined in the Pharmacy Refill Protocol, and if they do, the pharmacist is able to renew the prescription on the providers behalf without the request even being sent to the provider. When the prescription/patient do not meet the refill protocol requirements the pharmacist will propose the medication to the provider for approval. If the refill request is for a controlled substance, a message will be sent to the provider in message center with the details about the request.

Clinic pharmacists are also responsible for anticoagulation monitoring for our patients on Coumadin. They are available for completing Drug Utilization Reviews in order to make recommendations about maximizing therapy and minimizing drug interactions, as well as patient counseling upon request by a provider. Clinic pharmacists also spend a significant amount of time gathering information to submit to insurance companies for prior authorizations.

===MAT Pharmacist===
The MAT Pharmacist works closely with the MAT (Medical Assistance Team) program to assist with initiation and ongoing treatment of patients with substance use disorders. This person also has responsibilities related to the pain committee and facilitates regular pain committee meetings, pill audits, and urine drug screens when necessary.

===Outpatient Pharmacist===
*Monday-Friday 9am-7pm , closed holidays
*Outpatient Pharmacy 1 and Outpatient Pharmacy 2 pharmacist roles are available in tigertext

Outpatient pharmacists are responsible for traditional “pharmacy” jobs associated with filling prescriptions. There are typically 5 outpatient pharmacists scheduled each day. Two of the five are responsible for data entry, two are responsible for verification/checking of completed prescriptions, and the fifth pharmacist does most of the counseling and floats between data entry and checking depending on the need. Data entry for each prescription is done by a pharmacist who has access to the patient chart. A clinical review is done by the data entry pharmacist who evaluates the prescription for appropriate therapy, dose, frequency, duration, etc. Once the prescription has been entered by a pharmacist, the prescription is filled by a technician and then checked by a second pharmacist. This pharmacist is also doing a clinical check, but they are also checking the final product to make sure that what has been prepared for the patient matches what was prescribed. Once a new prescription has been verified, patients will be called to a counseling room to speak with the counseling pharmacist who will tell them about their medication, expected or possible side effects, how and when to take it and any potential drug interactions. The multi pharmacist involvement is by design to decrease errors and ensure that our patients get the very best care.

“Outpatient pharmacy” is where prescriptions are filled. In Cerner, there are two different pharmacies. There is a YKHC Pharmacy and a YKHC Clinic Dispensed Pharmacy. Sometimes there is confusion about which of them should be chosen by the ordering provider. There are always exceptions to every rule, but in general, if it is something that should be filled by the pharmacy and given/mailed to the patient, it should be sent to YKHC Pharmacy. If the prescription is documentation of something that a patient received in a village clinic or the Emergency Room (to take home with them), then the prescription should be sent to the Clinic Dispensed Pharmacy.

===Village Ops Pharmacist===
*Monday-Friday 8:30am-5:30pm, closed holidays
*Village Ops pharmacist available in tigertext

Village Ops pharmacist is a newer position within the department. It is a pharmacist who is specifically responsible for prescriptions that are sent to the Clinic Dispensed Pharmacy. The Village Ops pharmacist receives and reviews the prescriptions written pursuant to health aide, SRC provider, or village travel visits, as well as prescriptions written in the emergency room overnight (that were removed from the pickpoint). They are a great, dedicated resource for providers in villages and for health aides and SRC providers.

===Inpatient Pharmacist===
*7 days a week 7 am-7 pm
*Pharmacist on-call 24 hours a day
*Inpatient Pharmacy on-call pharmacist role available in tigertext
*''Inpatient Pharmacy will respond to Code Blues, intubations, C-sections, or other critical patients during business hours if their presence is requested. They are available for consults outside of regular hours, and will come in when the situation meets these criteria''
**medications only stocked in pharmacy (e.g. hypertonic 3% saline, altaplase)
**certain level of trauma
**mass casualties

Inpatient Pharmacists are responsible for care of patients in the inpatient units (Adult, Peds, and OB), as well as patients in the Emergency room and in the OR. All orders are verified by a pharmacist and the majority of orders are available in an automated dispensing cabinet (Pyxis) on each unit. But, when the ordered medication is not available on the unit, or is an injectable medication that needs to be compounded by the pharmacy, the medication will be prepared in the pharmacy and will be delivered to the unit for administration to the patient. Inpatient pharmacists are trained to participate in rapid sequence intubations when requested and assist with Codes. Inpatient pharmacists attend multidisciplinary rounds on admitted patients and make therapy recommendations when appropriate. Inpatient pharmacists play a vital role in antibiotic stewardship in the inpatient setting, and are great resources for drug questions of all kinds.

==Scope of Services==
Pharmacy services are patient-centered and are directed toward optimal patient care outcomes, health promotion, and disease prevention. Pharmacy services purpose is to assure efficacious, safe, and cost- effective drug therapy and appropriate outcomes in the use of drugs and medicines in the communities served.

'''Outpatient Services''': Medical history review, interviewing patients for medication history, filling of prescriptions, patient counseling/education including food/nutrient interactions, cytotoxic IV preparation, distribution of medications to village and subregional clinics, drug information.

'''Inpatient Services''': Preparation of sterile products (IV admixtures, piggybacks, syringes), medication histories, monitoring of drug therapy, drug information, discharge counseling/education on medications including food/nutrient interactions.

'''Drug Information/Education''': Provided by a licensed pharmacist for patients and health care providers.

'''Personnel/Administration & Management''': Recruitment and retention, staff development, development of department budget, maintains appropriate records for controlled substances, personnel management, scheduling, planning.

'''Supply and Distribution''': Procurement of needed supplies from various vendors; distribution of medications to nursing units and clinics, vaccines to villages and clinics, prepackaging of medications and monitoring drug recalls, inventory management, cost accounting.

'''QC/QA/QI''': Maintain Drug Utilization Reviews, Pharmacy and Therapeutics Committee, Drug Utilization Evaluations, Quality Controls, Adverse Drug Reactions, Non-Formulary requests, Clinical Guidelines, Staff Competencies/Training, and other Quality Improvement activities.

==Mechanism Used to Meet Patient Care Needs==
The Pharmacy maintains a QC/QA/QI plan which includes drug utilization review, drug utilization evaluations, adverse drug reaction monitoring, non-formulary request monitoring, clinical guideline monitoring/development, competency evaluations, pharmacist/DEA/FDA license monitoring, pharmacists dispensing review, chemotherapy dispensing review, Pharmacy & Therapeutics Committee activities, and various other quality control (patient waiting times, assessment of patient understanding of counseling, etc.) and quality improvement activities as determined. The Pharmacy also maintains workload indicators that are used to determine the application of existing resources and for strategic planning.

==How the Unit is Staffed to Meet Patient Care Needs==
The Pharmacy is staffed with 45 pharmacy employees. Pharmacists account for 20 FTE's, Technicians account for 20 FTE's, and other support staff for 5 FTE's. Competency of staff is determined as new staff goes through orientation and the initial 3- month probationary period, in addition, each employee has an annual competency evaluation in conjunction with their performance appraisal. Workload indicators are continually monitored for adjustments in staffing (location, hours, FTE's, etc.).

==Process Used for Acting on Both Positive and Negative Variances==
The Pharmacy Department monitors workload activities and builds staffing schedules to accommodate the provision of care. Training and leave requirements are adjusted in order to assure the proper provision of care. Recruiting activities are on going and pharmacy intern(s) and TDY(s) fill any gaps in staffing.

==Formularies==
Formularies at YKHC are managed by Pharmacy through the P&T Committee.

Follow [[:Category:Formularies|this link]] to see links to pdf files of YKHC formularies for the main hospital, sub-regional clinics, and village clinics. A link to the Lifemed medevac formulary is also included.

==Non-Formulary Medication Requests==
[https://ykhc.ellucid.com/documents/view/704 POLICY: Non-Formulary Medication Requests] (links to MCN)

Requests for non-Formulary Medication are made when an alternate medication already on the YKHC formulary is not appropriate for patient care.

Any provider can request a medication be obtained as non-formulary by filling out [[https://ykhc.ellucid.com/documents/view/35039 this form]]. It is reviewed and approved/rejected by the pharmacy director. To maximize the chances of the drug being approved, include as much information as possible, including other regimens that have been tried, history of intolerances, reasons why formulary options are not appropriate, etc.

If three or more patients are on a non-formulary drug, it will be brought to P&T to vote on adding it to the formulary.

Click [https://ykhc.ellucid.com/documents/view/35039 here] for a fillable request form located in Policy Manager.

==[[Pharmacy Things to Know]]==
Click above to see a list of pharmacy clinical pearls for providers.

[[:category:Ancillary Services]]

Guide to YKHC Medical Practices

2023-02-01T02:00:30Z

JenniferH:

{|style="margin: auto; width: 100%"
|-
|style="vertical-align:top; height:80px" colspan="4"|Welcome to the online Provider Orientation Manual—Guide to Medical Practices— for the Yukon-Kuskokwim Health Corporation. This manual is intended to be a resource for medical providers considering work at YK, new staff, locums and residents. It is intended to be a resource that is accessible and quickly available from the YK intranet and from outside the system. Use the table below to explore information about Bethel, the surrounding area, and the regional hospital, YKHC.
|-
!colspan="3"|GENERAL INFORMATION AND ORIENTATION
----
!style="text-align:center; width: 25%"|CLINICAL RESOURCES
|-
!style="text-align:left; width: 25%"|INTRODUCTION
!style="text-align:left; width: 25%"|NEW HIRE ORIENTATION
!style="text-align:left; width: 25%"|GENERAL INFORMATION
|style="text-align:center; width: 25%" rowspan="2"|
[[:Category:YKHC Guidelines|Guidelines and Protocols]]
 [[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]
 [[:Category:Formularies|Formularies]]
 [[media:Antibiogram.pdf|Antibiogram]]
 [[Antibiotic Stewardship]]
 [[Forms]]
 [[Maps]]
 [[Policies – Clinical]]
 [[:Category:Medical Staff Policies|Policies-Medical Staff]]
 [[:Category:Patient Care References|Presentations and Articles]]
 [[Travel]]
|-style="vertical-align:top;"
|style="text-align:left; width: 25%"|
[[Wiki Orientation]]
 [[People, Place, and Culture]]
 [[Bethel A to Z]]
 [[:Category:Overview of YKHC Medical Practices|Medical Practice Introduction]]
 [[Job Duties|Job Descriptions]]
|
[[:Category:Before Starting Work at YKHC|Before Starting Work]]
 [[Preparing for Living in Bethel|Living in Bethel]]
 [[Benefits]]
 [[YK Orientation|YK Provider Orientation]]
 [[Nursing Orientation]]
|
[[Meetings]]
 [[Tiger Connect|Tiger Connect (YK paging system)]]
 [[:Category:RAVEN|Electronic Health Records (EHR)]]
 [[Systems Access]]
 [[Continuing Medical Education]]
|-
!colspan="3"|CLINICAL SERVICES, WORKFLOW, AND RESOURCES
----
|-
!style="text-align:left; width: 25%"|EMERGENCY SERVICES
!style="text-align:left; width: 25%"|PRIMARY CARE SERVICES
!style="text-align:left; width: 25%"|HOSPITAL SERVICES
!style="text-align:center; width: 25%"|SUPPORT SERVICES
|-style="vertical-align:top;"
|style="text-align:left; width: 25%"|
[[:Category:Emergency Room|Emergency Department]]
 [[:Category:YKHC Guidelines#Critical Care & Emergency Medicine|Emergency Guidelines]]
 [[:Category:Medevacs and Transport|Medevacs and Transport]]
 [[Emergency RMT Scenarios and Responses|Emergency RMT Scenarios]]
 [[Emergency Medications Available in the Village|Emergency Medications in the Village]]
 [[Code Blue & Rapid Response]]
 [[SART|Sexual Abuse Response Team (SART)]]
|style="text-align:left; width: 25%"|
[[Audiology]]
 [[:Category:Dental|Dental]]
 [[:Category:Optometry|Optometry]]
 [[:Category:Outpatient|Outpatient Primary Care]]
 [[Pharmacy]]
 [[Physical Therapy]]
 [[:Category:Women's Health|Women’s Health]]
|style="text-align:left; width: 25%"|
[[Anesthesia Services|Anesthesia]]
 [[:Category:Inpatient|Hospitalist]]
 [[:Category:OB & Newborn|OB & Newborn]]
 [[:Category:Pediatrics|Pediatrics]]
 [[:Category:OR|Surgery Department]]
|style="text-align:center; width: 25%" rowspan="6"|
[[Case Management]]
 [[Community Relations/Translation]]
 [[Diabetes]]
 [[Dietary]]
 [[Endoscopy Lab]]
 [[Family Infant Toddler (FIT)]]
 [[Immunizations/Well Child|Well-Child Immunizations]]
 [[Infection Control|Infection Control / Employee Health]]
 [[McCann Treatment Center]]
 [[Morgue]]
 [[Office of Environmental Health|Office of Environmental Health (OEH)]]
 [[Prematernal Home]]
 [[Qavartarvik Hostel]]
 [[Social Services]]
 [[Technology]]
 [[Tobacco Cessation]]
 [[Women Infant Children (WIC)]]
 [[Wound Care]]
 '''[[Community Resources]]'''

|-
!style="text-align:left; width: 25%"|VILLAGE HEALTH
!style="text-align:left; width: 25%"|TELEHEALTH SERVICES
!style="text-align:left; width: 25%"|SPECIALTY CARE SERVICES
|-style="vertical-align:top;"
|style="text-align:left; width: 25%"|
[[Community Health Aide Training|Community Health Aide Program]]
 [[:category:SRC Clinic Provider Orientation|Subregional Clinics (SRCs)]]
 [[Village Trips]]
|
[[:Category:Radio Medical Traffic (RMT)|Radio Medical Traffic (RMT)]]
 [[:Category:Telemedicine/AFCHAN|Telemedicine]]
 [[Video Teleconferencing (VTC)]]
|
[[:Category:Behavioral Health|Behavioral Health]]
 [[Infusion Clinic]]
 [[:Category:Consults|Consults and Sub-Specialty Services]]
 [[Specialty Referrals]]
 [[STAR Clinic and Child Abuse Team|STAR Clinic]]
 [[LTC|Long Term Care (YK Elders Home)]]
|-
!style="text-align:left; width: 25%"|DIAGNOSTIC SERVICES
!style="text-align:left; width: 25%"|
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Specialty Referrals

2023-01-31T17:32:55Z

JenniferH: /* Cardiology (Adult) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)
'''Clinics Available'''
*ANMC Cardiology
**all referrals are reviewed for possible scheduling at Bethel Field Clinic
''any time you consult with a Cardiologist at ANMC who requests that a patient be seen in the cardiology field clinic at YKHC, please send the patient information over to Case Management to coordinate scheduling''

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Developmental (Pediatric)==
'''Orders Available'''
*Refer to Family, Infant, Toddler Program Internal
*Refer to Child Family Developmental Services External
*Refer to Peds Other External (Ability Clinic)
see [[Specific_Types_of_Appointments_and_Procedural_Processes#Developmental_Delay|Specific Pediatric Processes Section about Developmental Delay]] for more details.

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Adult)==
'''Orders Available'''
*Refer to Adult Gastroenterology External
'''Clinics Available'''
*ANMC Gastroenterology Clinic
*Internal Medicine Associates

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specific Types of Appointments and Procedural Processes

2023-01-31T17:29:24Z

JenniferH: /* Developmental Delay */

==Dental Pre Op Appointments==
* Review patient chart for past medical and surgical history, recent hospitalizations and recent illness via RMT. Review current medications and complete medication reconciliation.
* Document physical exam
* Complete pre-op form and indicate if patient is cleared for surgery.
[[file:Sickvisitnote.jpg]]
**If not cleared for surgery contact surgical department and make the department aware
**If you are uncertain if a patient is appropriate for surgery in Bethel, please discuss the case directly with the CRNA prior to approving or denying the surgery. We have CRNA’s to do anesthesia for pediatric cases here; more complicated patients who require an anesthesiologist’s presence are more appropriately managed in Anchorage.

*Return chart to clerk and inform nurse that patient is ready to be transported to surgery department.

==Well Child and Sports Physical Appointments==

#Well child forms are located in RAVEN. Obtain the correct form for the age of your patient. If patient falls at an in between age use the lower age and document appropriate developmental age.
#Review patient chart for past medical and surgical history, recent hospitalizations and recent illness via RMT. Review current medications and perform reconciliation.
#Document Physical Exam
#Apply Flouride varnish to teeth if indicated. Located in physician consult room.
#Order current immunizations needed. Inform nurse that patient is ready for vaccines. Order varicella prior to appointment since it comes from pharmacy and can take up to 30 minutes.
#Give patient a reach out and read book at appropriate ages located in physician consult room
#Adolescent patients: Remember to review SBRIT (ages 14-20) and IMPACT Form for ages 15-20. Make appropriate referrals as needed.
#Sports Physical: Make sure parent has completed history on form. Document physical exam on form. Make a photocopy which will be scanned by clerk into multimedia section of RAVEN and hand parent the original form. Please make sure to check for hernia on exam if not previously documented.
#Head Start Program: Requires a PPD to be placed and reported before patient can start. Give parent a copy of well child form.

==Developmental Delay==
''(last updated 11/17/20)''

see [[Specialty_Referrals#Developmental_.28Pediatric.29|Developmental (Pediatric) section in Specialty Referrals]] for Orders Available

===If the child is less than 3 years old===
please be sure to submit a '''[[Family Infant Toddler (FIT)|FIT (Family Infant Toddler Program)]] referral'''. Anyone can submit a FIT referral- health aides, providers, even the family can call and ask for an evaluation. You can submit a FIT referral from an RMT. This is for any delays with speech, gross motor, or fine motor. They can also start early before any delays are noted in patients who have risk factors for delay.

===Language delay and/or fine motor delay only===
*if older than 3 years old or severe delay
*'''Ability clinic in Anchorage''' can see these patients. They have a 4-6 week wait list currently for speech therapists, none for OT. They can do telehealth with village based patients.
*To make a referral to Ability clinic, please choose “Refer to Peds Other” and one of the drop down options is Ability Clinic.
*(Ability clinic does not have a consistent physical therapist)

===Multidisciplinary Neurodevelopmental Clinic===
*If they are a NICU graduate, you have concern for Autism or Fetal Alcohol Exposure, or they have enough complicating issues that you think they would benefit from a full evaluation
*Order: '''"Refer to Child Family Developmental Services External"''' (included in below power plan)
*We have a specific power plan for the Child and Family Developmental Services Clinic at ANMC now.
**In the Peds Referral folder (or by searching ''AMB Developmental Delay Referral External'') you can access this power plan. It is also now included on all Well Child Powerplans.
*Be clear which clinic you are specifically referring to (NICU grad, autism, FASD, Neurodevelopmental clinic, or just PT/OT/ST)
*For any of the multidisciplinary clinics, they require a full documented Well Child visit within the last 12 months with the referral. Hearing and vision screens are helpful to get if able, but can also be scheduled in conjunction with initial evaluation in Anchorage.
**If the child has not had hearing (hearing screening machine available in outpatient clinic) or vision screening (Snellen test) within the past 12 months, place in the comments, “child requires hearing and vision screening in Anchorage.” and will get scheduled the day prior to appointment
*They will need to complete the CFDS Parent Questionnaire and CFDS Teacher Packet forms before a visit will be scheduled. Families can call the CFDS clinic to speak with a case manager who can help complete the forms. If you have time during a clinic visit or hospital stay, please assist the families, as these are quite in depth paperwork.

'''For non-pediatric provider:''' if you have any questions or think they need a more specific referral, you are welcome to either refer to pediatricians at YKHC for in person or telehealth OR consult a pediatrician by Tiger Texting them (Peds Wards on Duty or the inpatient or outpatient pediatrician directly).

''If you think the child would benefit from pediatrician evaluation, we are doing a lot more telehealth now and we can get a lot done with good parent reporting. Please be sure to refer these kids to Bethel for pediatrician evaluation. Message the ChronicPediatricsCaseManagement Raven message address if you need any special attention.''

[[:category:Pediatrics|Pediatrics Main Page]]

Specialty Referrals

2023-01-31T17:26:46Z

JenniferH: /* Developmental (Pediatric) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)
'''Clinics Available'''
*ANMC Cardiology
**all referrals are reviewed for possible scheduling at Bethel Field Clinic

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Developmental (Pediatric)==
'''Orders Available'''
*Refer to Family, Infant, Toddler Program Internal
*Refer to Child Family Developmental Services External
*Refer to Peds Other External (Ability Clinic)
see [[Specific_Types_of_Appointments_and_Procedural_Processes#Developmental_Delay|Specific Pediatric Processes Section about Developmental Delay]] for more details.

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Adult)==
'''Orders Available'''
*Refer to Adult Gastroenterology External
'''Clinics Available'''
*ANMC Gastroenterology Clinic
*Internal Medicine Associates

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T17:25:40Z

JenniferH: /* Developmental (Pediatric) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)
'''Clinics Available'''
*ANMC Cardiology
**all referrals are reviewed for possible scheduling at Bethel Field Clinic

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Developmental (Pediatric)==
'''Orders Available'''
*Refer to Family, Infant, Toddler Program Internal
*Refer to Child Family Developmental Services External
see [[Specific_Types_of_Appointments_and_Procedural_Processes#Developmental_Delay|Specific Pediatric Processes Section about Developmental Delay]] for more details.

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Adult)==
'''Orders Available'''
*Refer to Adult Gastroenterology External
'''Clinics Available'''
*ANMC Gastroenterology Clinic
*Internal Medicine Associates

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T17:24:41Z

JenniferH: /* Developmental (Pediatric) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)
'''Clinics Available'''
*ANMC Cardiology
**all referrals are reviewed for possible scheduling at Bethel Field Clinic

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Developmental (Pediatric)==
'''Orders Available'''
*Refer to Child Family Developmental Services External
see [[Specific_Types_of_Appointments_and_Procedural_Processes#Developmental_Delay|Specific Pediatric Processes Section about Developmental Delay]] for more details.

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Adult)==
'''Orders Available'''
*Refer to Adult Gastroenterology External
'''Clinics Available'''
*ANMC Gastroenterology Clinic
*Internal Medicine Associates

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T17:22:23Z

JenniferH: /* Dermatology (Pediatric) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)
'''Clinics Available'''
*ANMC Cardiology
**all referrals are reviewed for possible scheduling at Bethel Field Clinic

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Developmental (Pediatric)==
'''Orders Available'''
*Refer to Child Family Developmental Services External

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Adult)==
'''Orders Available'''
*Refer to Adult Gastroenterology External
'''Clinics Available'''
*ANMC Gastroenterology Clinic
*Internal Medicine Associates

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T17:19:11Z

JenniferH: /* Cardiology (Adult) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)
'''Clinics Available'''
*ANMC Cardiology
**all referrals are reviewed for possible scheduling at Bethel Field Clinic

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Adult)==
'''Orders Available'''
*Refer to Adult Gastroenterology External
'''Clinics Available'''
*ANMC Gastroenterology Clinic
*Internal Medicine Associates

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T17:11:51Z

JenniferH: /* Gastroenterology (Pediatric) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Adult)==
'''Orders Available'''
*Refer to Adult Gastroenterology External
'''Clinics Available'''
*ANMC Gastroenterology Clinic
*Internal Medicine Associates

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T17:06:33Z

JenniferH: /* Ophthalmology (Pediatric) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T17:06:18Z

JenniferH: /* Ophthalmology (Pediatric) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T17:04:32Z

JenniferH: /* Optometry/Ophthalmology */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:59:50Z

JenniferH: /* Neurology (Pediatrics) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:57:05Z

JenniferH: /* Neurology (Pediatrics) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
*Seattle Children's Pediatric Neurology
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:56:24Z

JenniferH: /* Endocrinology (Pediatric) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
*Seattle Children's Pediatric Neurology

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:52:55Z

JenniferH: /* Dermatology */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Available Clinic'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
*Seattle Children's Pediatric Neurology

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:46:14Z

JenniferH: /* ACT/Behavioral Health */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Available Clinic'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
*Seattle Children's Pediatric Neurology

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:43:16Z

JenniferH: /* Nephrology (Adult) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Available Clinic'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
*Seattle Children's Pediatric Neurology

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:41:14Z

JenniferH: /* Endocrinology (Adult) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Available Clinic'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
*Seattle Children's Pediatric Neurology

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:36:45Z

JenniferH: /* Hepatology (Adult) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
*Seattle Children's Pediatric Neurology

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:36:12Z

JenniferH: /* Hepatology (Adult) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)
'''Order Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
*Seattle Children's Pediatric Neurology

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:30:27Z

JenniferH: /* MRI (Pediatric) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
*Seattle Children's Pediatric Neurology

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:30:11Z

JenniferH: /* MRI (Adult) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order AVailable'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast?: yes or no

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
*Seattle Children's Pediatric Neurology

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:27:45Z

JenniferH: /* Neurology (Adult) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
*Seattle Children's Pediatric Neurology

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:25:10Z

JenniferH:

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Specialty Referrals

2023-01-31T16:23:19Z

JenniferH: /* Cardiology (Adult) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology Internal
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Pictures (REQUIRED with all derm referrals)

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==OB/GYN Referrals==

'''Orders Available'''
*Refer to OB/GYN Surgery Internal Cleared
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer OB/GYN Surgery Internal Cleared'''
*Order: Refer to OB/GYN Surgery Internal Cleared
*This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
*Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
*If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
*Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
*Make sure you complete all of the information and call or message Dr. Compton if you have questions.
*If you cannot reach Dr. Compton, contact Brenda Lamont.

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[media:Rheumatology_Field_Clinic_Pre-visit_Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy or other minor procedures to be done in Bethel'''
*Order: "Refer to Adult Surgery Internal - YK General"
*The queue is managed by the Surgery Case Manager.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[media:Use_of_Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

Ischemic Stroke – Acute

2023-01-31T15:34:47Z

JenniferH:

Generally speaking, all acute CVA patients should be transferred from ER to ANMC for full stroke workup and better access to consistent PT/OT/SLP.

Patients who decline transfer, particularly those without hemorrhage who have returned to neurologic baseline, could be monitored for 1-2 days at YKHC to monitor for worsening, screen for arrhythmia on telemetry, and work with our physical therapy colleagues. These patients should then be referred to ANMC neurology for MRI, echo, and carotid imaging (if not done in Bethel).

===YKHC Stroke Clinical Guideline Development===
Drs. Jeremy Wood and Peek Ehlinger created the YKHC stroke guideline with the goal of improving care for our patients treated both in the YKHC hospital and nearby region. One of the goals was to encourage earlier identification of strokes that may be amenable to thrombectomy. The emergence of an intervention for large vessel occlusion strokes has changed the diagnostic pathway and treatment algorithm for stroke. It is an area of active development that we should expect will change over the next few years.

Thrombectomy for appropriate LVO strokes appears to have a much more hopeful risk versus benefit ratio than does thrombolytics for the undifferentiated ischemic stroke, however, in general the area of stroke treatment has a fair bit of controversy and you will likely hear different things from different people. We tried to emphasize the importance of bringing neurology along in this decision, and it’s OK to defer to them.

Thrombolytics have been shown to provide net benefit in a select group of patients, however, they also can harm at rates that increase due to a number of factors, such as time from stroke onset (i.e. data stronger for <3 hours than between 3 and 4.5) and patient specific risk factors. Be sure to take your time with the exclusion criteria and consideration of stroke mimics.

We currently have stocked tenectaplase in the ED, which is the direction that most stroke centers are going.

====Shared Decision Making====
Shared decision making is often difficult in a patient with a disabling stroke and may not be necessary or possible in all patients. As the patient may not have capacity to participate in decisions, you may need to enlist the help of a surrogate decision maker or proceed under presumed consent in such cases when the benefits clearly outweigh the harms. The included consent form is a suggested reference to review anticipated risks and benefits. There is an online resource that has been clinically validated ([http://www.sorcan.ca/iscore/ iScore]) which also may be of some use.

'''Verbal Consent example from UpToDate'''
*"There is a treatment for your stroke called alteplase that must be given within 4.5 hours after the stroke started. It is a 'clot-buster' drug. Getting alteplase reduces your risk of being disabled. People who get alteplase for stroke have a better chance of recovering without disability and getting back to the activities they enjoy compared to people who do not receive the treatment. All medicines have some risk. With alteplase, there is a risk of serious bleeding. However, time is important as well. We know that the sooner we start treatment with alteplase, the greater the chance that patients will have a good outcome."

====Revision of Written Consent form—numbers from Lancet 2014 article====

'''Benefits:'''
*< 3 hours: 33% of stroke patients given alteplase had good outcome, whereas 23% of stroke patients controls (no alteplase) also got better. 10 people would have to get the drug to help 1 person have a good outcome.
*Between 3 and 4. 5 hours from stroke onset: 35% of patients receiving alteplase had a good outcome, and 30% of patients who didn’t get the drug also got better. You would have to treat 20 people to help 1 person have a good clinical outcome.

'''Risks:'''
*In large series of stroke patients, 6.8% of them had bleeding in their brain after receiving alteplase for stroke, versus 1.3% of those stroke patients who did not receive the drug. If we give this drug 18 times, chances are it will make one person have bleeding in their brain.
*2% of people given this drug die from a hemorrhage (absolute risk) however by 3-6 months out those that receive the drug within 3 hours have a 10% (absolute increase) increased chance of disability-free survival, and that drops to 5% between 3 and 4.5 hours.

===Resources/References===
* [[media:Stroke.pdf|Acute Ischemic Stroke YKHC Clinical Guideline]]
* [[Stroke (CVA)|Stroke RMT Guide]]
* [http://www.sorcan.ca/iscore/ iScore]
* Siket Matt, Marcolini Evadne, Ganti Latha. [https://www.emrap.org/corependium/chapter/recEAr4nPXQE4eOBH/Transient-Ischemic-Attack-and-Acute-Ischemic-Stroke Transient Ischemic Attack and Acute Ischemic Stroke.] In: Mattu A and Swadron S, ed. CorePendium. Burbank, CA: CorePendium, LLC. https://www.emrap.org/corependium/chapter/recEAr4nPXQE4eOBH/Transient-Ischemic-Attack-and-Acute-Ischemic-Stroke.
* Emberson J et al.; Stroke Thrombolysis Trialists' Collaborative Group. [https://www.sciencedirect.com/science/article/pii/S0140673614605845?via%3Dihub Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials.] Lancet. 2014 Nov 29;384(9958):1929-35. doi: 10.1016/S0140-6736(14)60584-5. Epub 2014 Aug 5. PMID: 25106063; PMCID: PMC4441266.
* [[media:Alaska Stroke Systems of Care 7.29.17.pdf|Alaska Stroke Systems of Care]] (PowerPoint Presentation)

[[:category:YKHC Guidelines|YKHC Clinical Guidelines]]
 [[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]

DME equipment

2023-01-31T15:10:48Z

JenniferH: Created page with "==Standard Commode== #Patient is physically incapable of utilizing toilet facilities. This would occur in the following situations: ##The patient is confined to a single room..."

==Standard Commode==
#Patient is physically incapable of utilizing toilet facilities. This would occur in the following situations:
##The patient is confined to a single room (confinement to a single room means the patient is bedridden, cannot walk with a cane or walker, or cannot use or be wheeled in a wheelchair to access the bathroom) OR
##The patient is confined to one level of the home environment and there is no toilet on that level, OR
##The patient is confined to the home and there are no toilet facilities in the home
#Height and Weight within 30 days of prescription

==Extra Wide/Heavy Duty Commode Chair==
#Patient meets standard commode requirements AND
#Weight > 300lbs documented in medical record within 30 days of prescriptions

==Drop-Arm Commode==
#Patient meets standard commode requirements AND
#Detachable arms feature is necessary to facilitate transferring the patient or if the patient has a body configuration that requires extra width

A commode is NOT covered by Medicare for the following conditions/situations:
*Urinary urgency or incontinence
*Slow gait and cannot get to the bathroom in a timely manner
*Patient is able to walk with or without an assistive device, are able to use a wheelchair in the home, and are able to get to the bathroom

==Semi Electric Hospital Bed==
#One or more of the following criteria:
##Medical condition which requires positioning of the body in ways not feasible with an ordinary bed
##Requires positioning of the body in order to alleviate pain
##Requires head of bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration
##Requires traction equipment, which can only be attached to a hospital bed
#Requires frequent changes in body position and/or has an immediate need for a change in body positions (i.e. a patient has large or multiple pressure ulcers on the trunk or pelvis and needs to be repositioned frequently and is unable to do so without assistance; or the patient has limited strength to move or shift their body)

Height: _
Weight: _
Wheelchair size: _

==Standard Manual Wheelchair==
#All of the following criteria are met:
##Mobility limitations impairing MRADLs (mobility-related activities of daily living: toileting, feeding, dressing, grooming, bathing, etc) in customary locations in the home
##Cannot be sufficiently resolved with a cane or a walker
##Will improve the patient’s ability to participate in MRADLs
##Client will to use wheelchair
##Height and weight within 30 days of prescription
#AND one of the following are met:
##Patient able to safely propel wheelchair themselves
##Caregiver available and will to push client in chair

==Hemi Wheelchair==
#Standard Manual Wheelchair criteria met AND one of the following:
##Lower seat height (17” to 18”) required due to short stature
##Patient needs to place feet on the ground for propulsion

==Lightweight Wheelchair==
#Standard Manual wheelchair criteria met AND both of the following:
##Unable to self-propel in standard chair
##Able to self-propel in lightweight chair

==Heavy Duty Wheelchair==
#Standard manual wheelchair criteria met AND one of the following:
##Weight over 250 lb
##Severe spasticity

==Extra Heavy Duty Wheelchair==
#Standard wheelchair criteria met AND
#Weight over 300 lbs

Physical Therapy

2023-01-31T15:02:04Z

JenniferH:

The Physical Therapy Dept. is located in the main hospital on the second floor. They see any and all patients with physical problems needing rehabilitation occurring from injury or other reasons.

* individualized and on-going physical therapy evaluations
* progressive individualized therapeutic exercise programs
* wound care ([[media:Wound Care.pdf|Basics of Wound Care PowerPoint Presentation by Keira Gefroh]])
* advice on ergonomics and home safety
* orthopedic supplies such as braces and exercise bands, etc
* ordering [[DME equipment]]: walkers and wheelchairs
* stroke and other neuro rehabilitation
*''knee injections are not done by PT, but by providers in clinic''
They also travel to all of the subregional clinics several times a year to treat patients in these areas.

===Ortho Bethel Field Clinic===
All referrals to ortho are reviewed by PT. The Ortho field clinic is often full, thus patients may not be scheduled with the next field clinic.

When making a referral to ortho, make sure to obtain appropriate XRs as these can be helpful if an ortho Telehealth appointment is scheduled.

Specific Types of Appointments and Procedural Processes

2023-01-31T15:00:52Z

JenniferH: /* Multidisciplinary Neurodevelopmental Clinic */

==Dental Pre Op Appointments==
* Review patient chart for past medical and surgical history, recent hospitalizations and recent illness via RMT. Review current medications and complete medication reconciliation.
* Document physical exam
* Complete pre-op form and indicate if patient is cleared for surgery.
[[file:Sickvisitnote.jpg]]
**If not cleared for surgery contact surgical department and make the department aware
**If you are uncertain if a patient is appropriate for surgery in Bethel, please discuss the case directly with the CRNA prior to approving or denying the surgery. We have CRNA’s to do anesthesia for pediatric cases here; more complicated patients who require an anesthesiologist’s presence are more appropriately managed in Anchorage.

*Return chart to clerk and inform nurse that patient is ready to be transported to surgery department.

==Well Child and Sports Physical Appointments==

#Well child forms are located in RAVEN. Obtain the correct form for the age of your patient. If patient falls at an in between age use the lower age and document appropriate developmental age.
#Review patient chart for past medical and surgical history, recent hospitalizations and recent illness via RMT. Review current medications and perform reconciliation.
#Document Physical Exam
#Apply Flouride varnish to teeth if indicated. Located in physician consult room.
#Order current immunizations needed. Inform nurse that patient is ready for vaccines. Order varicella prior to appointment since it comes from pharmacy and can take up to 30 minutes.
#Give patient a reach out and read book at appropriate ages located in physician consult room
#Adolescent patients: Remember to review SBRIT (ages 14-20) and IMPACT Form for ages 15-20. Make appropriate referrals as needed.
#Sports Physical: Make sure parent has completed history on form. Document physical exam on form. Make a photocopy which will be scanned by clerk into multimedia section of RAVEN and hand parent the original form. Please make sure to check for hernia on exam if not previously documented.
#Head Start Program: Requires a PPD to be placed and reported before patient can start. Give parent a copy of well child form.

==Developmental Delay==
''(last updated 11/17/20)''
===If the child is less than 3 years old===
please be sure to submit a '''[[Family Infant Toddler (FIT)|FIT (Family Infant Toddler Program)]] referral'''. Anyone can submit a FIT referral- health aides, providers, even the family can call and ask for an evaluation. You can submit a FIT referral from an RMT. This is for any delays with speech, gross motor, or fine motor. They can also start early before any delays are noted in patients who have risk factors for delay.

===Language delay and/or fine motor delay only===
*if older than 3 years old or severe delay
*'''Ability clinic in Anchorage''' can see these patients. They have a 4-6 week wait list currently for speech therapists, none for OT. They can do telehealth with village based patients.
*To make a referral to Ability clinic, please choose “Refer to Peds Other” and one of the drop down options is Ability Clinic.
*(Ability clinic does not have a consistent physical therapist)

===Multidisciplinary Neurodevelopmental Clinic===
*If they are a NICU graduate, you have concern for Autism or Fetal Alcohol Exposure, or they have enough complicating issues that you think they would benefit from a full evaluation
*Order: '''"Refer to Child Family Developmental Services External"''' (included in below power plan)
*We have a specific power plan for the Child and Family Developmental Services Clinic at ANMC now.
**In the Peds Referral folder (or by searching ''AMB Developmental Delay Referral External'') you can access this power plan. It is also now included on all Well Child Powerplans.
*Be clear which clinic you are specifically referring to (NICU grad, autism, FASD, Neurodevelopmental clinic, or just PT/OT/ST)
*For any of the multidisciplinary clinics, they require a full documented Well Child visit within the last 12 months with the referral. Hearing and vision screens are helpful to get if able, but can also be scheduled in conjunction with initial evaluation in Anchorage.
**If the child has not had hearing (hearing screening machine available in outpatient clinic) or vision screening (Snellen test) within the past 12 months, place in the comments, “child requires hearing and vision screening in Anchorage.” and will get scheduled the day prior to appointment
*They will need to complete the CFDS Parent Questionnaire and CFDS Teacher Packet forms before a visit will be scheduled. Families can call the CFDS clinic to speak with a case manager who can help complete the forms. If you have time during a clinic visit or hospital stay, please assist the families, as these are quite in depth paperwork.

'''For non-pediatric provider:''' if you have any questions or think they need a more specific referral, you are welcome to either refer to pediatricians at YKHC for in person or telehealth OR consult a pediatrician by Tiger Texting them (Peds Wards on Duty or the inpatient or outpatient pediatrician directly).

''If you think the child would benefit from pediatrician evaluation, we are doing a lot more telehealth now and we can get a lot done with good parent reporting. Please be sure to refer these kids to Bethel for pediatrician evaluation. Message the ChronicPediatricsCaseManagement Raven message address if you need any special attention.''

[[:category:Pediatrics|Pediatrics Main Page]]

File:Guidelines2017.pdf

2022-12-07T04:25:39Z

JenniferH: JenniferH uploaded a new version of File:Guidelines2017.pdf

2017 Clinical Guidelines

Intubation – Adult and Peds

2022-12-04T06:55:07Z

JenniferH: /* Resources/References */

*All intubated patients must be medevac’d to ANMC for ICU management. We do not have an ICU in Bethel and we do not have the resources to keep these patients.

===Resources/References===
*[[media:Intubation_adult_and_peds.pdf|Intubation (Adult and Pediatrics)]] (YKHC Clinical Guideline)
*[[media:ET_CO2.pdf|ET CO2 Monitoring in Ventilated Pediatric Patients]] (YKHC Clinical Guideline)
*[https://www.yumpu.com/en/document/read/30583331/respiratory-failure-in-children-stabilization-anthc Respiratory Failure in Children: Stabilization and Management] Powerpoint presentation by Drs. Bowman, Gonzales, and Engel (ANMC Pediatric Critical Care)
* Kabrhel et al. [https://www.nejm.org/doi/full/10.1056/nejmvcm063574 Orotracheal Intubation]. N Engl J Med 2007; 356:e15. DOI: 10.1056/NEJMvcm063574 (video)
* Lighthall et al. [https://www.nejm.org/doi/full/10.1056/NEJMvcm0909669 Laryngeal Mask Airway in Medical Emergencies]. N Engl J Med 2013; 369:e26. DOI: 10.1056/NEJMvcm0909669 (video)
* Hsiao, J. and Pacheco-Fowler, V. [https://www.nejm.org/doi/full/10.1056/NEJMvcm0706755 Cricothyroidotomy]. N Engl J Med 2008; 358:e25. DOI: 10.1056/NEJMvcm0706755 (video)
* Nickson, Chris. [https://litfl.com/difficult-airway-algorithms/ Difficult Airway Algorithms.] Life in the Fastlane (LITFL), 2020.
* [[media:Airway Evaluation - 5-7-2019.pdf|Airway Evaluation and Oral Pathology 2019]] (PowerPoint Presentation)

[[Common ED Procedures]]
 [[:category:YKHC Guidelines|YKHC Clinical Guidelines]]