We have transitioned from eConsult to KPHC/Cadence for ordering, direct booking, and appointment scheduling of many of the general ultrasound exams that are presently ordered from the eConsult specialty of Rad-Outpt ULS. Please note that not all ultrasound orders are being migrated at this time. The table below outlines which ultrasound orders will be directly placed in KPHC and which will continue to require an eConsult referral and a KPHC order (current state).
Chart Chat is now an essential tool to be leveraged between clinician in order to provide high quality patient care. Below are recommendations created with the intent to improve the communication between clinicians via KP HealthConnect Chart Chat in Kaiser Permanente NCAL.
Best Practices for Clinician-to-Clinician Chart Chat
Chart chat messages should be clinical and concise. Send as few messages as possible to minimize disruptions.
Use Emojis instead of acknowledgements like “Thank you” and “Got it!”. Emojis result in fewer interruptions as they do not push notifications to members of a conversation.
In the Inpatient space, Chart Chat can be used to communicate urgent/emergently, but discretion should be used by the sender, and if it is felt that a 20 minute response time interval is too long, direct (phone call) communication may be a better option.
If your chat conversations last longer than a few messages or if there is a complex issue requiring significant background information or discussion, consider a phone call as a better option.
Attach the patient chart to the chat if you are messaging about a patient. This better delineates to the receiving provider which patient the message is about.
If your chart chat remains unread after a reasonable amount of time, consider reaching out to the person via another mode of communication.
Haiku Best Practices:
Allow “Push Notifications”
Allow “Break Through Do Not Disturb Availability”. This allows you to set your status to Do Not Disturb (you will not get alerts from non-clinicians) while still being able to get clinician-to-clinician alerts. Recommended for providers who are “On-Call”
Allow “Play Sound” which will allow you to hear a new chart chat alert if you are in Haiku (but not in Chart Chat).
Login to Haiku at the beginning of your workday, similar to how you login to your computer. Logging in before getting a new message will allow you to take advantage of “message preview” on your KP iPhone home screen as well as the quick jump to Chart Chat from the KP iPhone home screen and also ClinConnect Haiku icon.
Getting into the habit of setting your status helps minimize accidental off-hour alerts.
Understanding availability statuses for providers:
When messaging someone via Chart Chat, the receiving individual’s “Availability Status” appears beside their name.
During daytime hours:
Available: The provider user is logged into a KPHC workstation.
Busy: The default status when a provider user is not logged into KPHC. If the person is working clinically that day, they will likely see your message the next time they log into KPHC or look at Haiku on their mobile device. Most clinicians who carry mobile devices with KPHC loaded will get a notification on their device.
Do Not Disturb: You can set this status when you are in a procedure or are “on-call” after normal clinical hours. Additionally, surgeons will have this status set automatically based on their OR cases. Users will not receive notifications on their mobile devices while they are in “Do Not Disturb” status, except from other clinicians (provided they have allowed “Break Through Do Not Disturb Availability”. This setting is meant to convey to staff that they should not expect a quick response to their message.
Offline: Users are not reachable by Chart Chat when in this status. This status is manually set by the user.
| Medication | Usual Dosage | Special Considerations |
|---|---|---|
| Haloperidol | 0.5 to 1mg q4h PO/IM/ IV prn | Best evidence in treating delirium, can cause akathisia as high potency, Needs telemetry if using IV |
| Olanzapine | 2.5mg QHS or BID and 1.25 mg q6hrs PRN | Can be deliriogenic. Good for sedation |
| Quetiapine | 12.5mg to 25 mg QHS PO plus 12.5mg q6h PRN | Sedating, anticholinergic. Worse for QTc. Best for Parkinson’s. LBD |
| Risperidone | 0.5 mg BID and 0.25mg q8hrs prn | High potency, can cause akathisia |
| Valproic Acid | 250mg BID, can increase to 500mg BID if well tolerated | Check VPA level 5th day (trough), Check LFTs, NH3 |
| Gabapentin | 100-300mg TID, scheduled or PRN | Check renal function before starting. Good for anxiety as well |
| Trazodone | 12.5mg BID, titrating up to 25mg BID to TID, standing or PRN for sedation | Use only for sedation. Can be deliriogenic |
1. Write a discharge summary (but use transfer summary template (see picture below); this is still in question per Eric Au’s email but Parv Kaur (HIM liaison) will clarify with medical records. For now, we should write a DC summary note
2. Ensure there is an order for NPO after midnight
3.Sign ambulance form (only done at Fremont)
4. Use “INTERFACILITY CARDIAC TRANSPORT ORDERS” order-set (see attachment 2). This order set includes the LOA order and cardiologist will click on the 4th option “Transport to another facility on a Leave of Absence-Returning” this will hold the bed for 4 hours (see attachment 3). Also click “yes” on medication reconciliation. We should not be writing a separate discharge order.
Nurse supervisor at SCL/SF will contact FRE/SLN supervisor if patient is staying or being discharged from receiving facility so our bed can be released.
Evaluate patient prior to transfer and ensure stable for transfer. Update transfer summary at time of discharge (if patient no transferred until the next day must be updated at time of transfer)
Patient must be examined at time of arrival to the receiving facility. Labs/imaging from the last time patient seen must be reviewed and any changes in physical exam or assessment/plan should be documented.
• Please do not copy orders for transfers between SLN and FRE
• Please be mindful of duplicate orders if copying orders for other facilities (ensure no repeat imaging-ct head etc order, transfer orders continued)
Stroke Alert
If “Go” for Stroke Alert: *Note: Creatinine waived for Stroke Alerts*
After CT/ CTA
ICU
For any patient that needs transfer for higher level or specific care…please call 855-327-0509 to initiate the process. This service team operates 24/7, and will coordinate all aspects of care to streamline the transfer. This replaces the prior method of PCC/House Supervisor initiated transfers. If you forget the number, it can be found on ClinConnect under “All KP Patient Transfer Center”. Cortext can be subsequently used for follow-up communication or to confirm ETAs, after the initial request via phone.
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