Harbor:Stress Testing

• OOP - refer back to in-network PCP for cardio workup
• DHS empaneled - message PCP for further cardio workup or schedule for stress test
  • 1 - Ensure patient is ambulatory (walk 2 blocks); if not able to complete a treadmill stress test, consult cardiology to determine best option
  • 2 - Send COVID test via "AMB Coronavirus Covid-19" order
    • Select "nasopharyngeal" then modify order
      • Change order for future visit to "no"
      • Change collection priority to "STAT"
    • If the stress test appointment is more than a week in advance, DHS patients can be tested at N26 (the COVID test has to be resulted within 3-7 business days of the procedure)
      • Modify to: "future order"; "RN collect"; "anterior nares"
      • Call x67786 (N-26) with any questions about the COVID testing procedure
  • 3 - Place order for "CV Treadmill Stress Test"
    • Reason for procedure "Chest Pain"
    • Special Instructions "Schedule in 3-4 business days"
  • 4 - In DEPART section, click "Schedule Follow-up Appointment" so clerk makes appointment prior to patient DC
    • If the COVID test is positive, the Cardiology fellow/attending at the Heart Station will call the patient to discuss
      • 1 - COVID symptoms
        • If asymptomatic for >10 days (or >20 days if severe COVID disease or immunocompromised), the appointment will stand
        • If symptomatic, the appointment will be canceled and the Cardiology fellow/attending at the Heart Station will message the empaneled PCP to ensure close follow-up
      • 2 - Cardiac Symptoms
        • The Cardiology fellow/attending at the Heart Station will call the patient to further risk stratify
          • If deemed high risk, Cardiology will schedule an alternate non-AGP stress test
          • If deemed low-risk, stress testing will be deferred to the PCP for follow up

• DHS Eligible without assigned PCP
  • 1 - Ensure patient is ambulatory(walk 2 blocks); if not able to complete a treadmill stress test, consult cardiology to determine best option
  • 2 - Send COVID test via "AMB Pre-surgical/Procedure Coronavirus COVID-19 Screening" order
    • Select "nasopharyngeal" then modify order
      • Change order for future visit to "no"
      • Change collection priority to "STAT"
  • 3 - Place order for "CV Treadmill Stress Test"
    • Reason for procedure "Chest Pain"
    • Special Instructions "Schedule in 3-4 business days"
  • 4 - In DEPART section
    • ***CCC for NERF*** (get a PCP assigned)
    • Click "Schedule Follow-up Appointment" so clerk makes appointment prior to patient DC
  • If the COVID test is positive, the Cardiology fellow/attending at the Heart Station will call the patient to discuss
    • 1 - COVID symptoms
      • If asymptomatic for >10 days (or >20 days if severe COVID disease or immunocompromised), the appointment will stand
      • If symptomatic, the appointment will be canceled and the Cardiology fellow/attending at the Heart Station will message the empaneled PCP to ensure close follow-up
    • 2 - Cardiac Symptoms
      • The Cardiology fellow/attending at the Heart Station will call the patient to further risk stratify
        • If deemed high risk, Cardiology will schedule an alternate non-AGP stress test
        • If deemed low-risk, stress testing will be deferred to CCC for follow up

Drs. Chappell, Shah, & Pillutla 8/19/2020