Harbor:Stress Testing: Difference between revisions

Latest revision as of 21:13, 1 May 2024

OOP - refer back to in-network PCP for cardio workup

DHS empaneled - if low risk, message PCP for further cardio workup or schedule for stress test (typically doing CCTA)
- The 2021 ACC Chest Pain Guidelines 2021 ACC Chest Pain Testing Guidelines (section 4)
  - 2021 AHA ED Chest Pain Testing Algorithm

DHS Eligible
- Low risk (HEART score <3, consider<4) - ensure patient goes to Registration Window 6 to finish the Medical application/empanelment process
- Intermediate to high risk, admit to CORE for further eval (typically CCTA, sometimes nuc test)
- On the rare occasion you sill feel the need to order the CV Treadmill Stress Test for "Chest Pain", the order goes to the Heart station and they will schedule the patient. It is not done by the ED clerk or ED PAC.
  - Remember, patients should be able to ambulate independently without a cane or walker for about 2 blocks, and make sure the EKG does not have resting ST abnormalities, LBBB, pacing or WPW
  - If they do not meet these criteria, consult cardiology to determine the best option
- The Cardiology fellow/attending at the Heart Station will further risk stratify
  - If deemed low-risk, stress testing will be deferred to the PCP for follow up
  - If deemed high risk, Cardiology will schedule an alternate non-AGP stress test
- If the stress test is abnormal, Cardiology will arrange f/up for the patient
  - If test is normal, no notification occurs.

Drs. Chappell & Shah, 5/1/2024

Authors:

@@ Line 1: / Line 1: @@
-* OOP - refer back to in-network PCP for cardio workup
+* '''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'''
+* '''DHS empaneled''' - if low risk, message PCP for further cardio workup or schedule for stress test (typically doing CCTA)
-** 1 - '''Ensure patient is ambulatory'''(walk 2 blocks); if not able to complete a treadmill stress test, consult cardiology to determine best option
+** The 2021 ACC Chest Pain Guidelines [https://www.ahajournals.org/doi/10.1161/CIR.0000000000001030 2021 ACC Chest Pain Testing Guidelines (section 4)]
-** 2 - Send COVID test  via "'''AMB Pre-surgical/Procedure Coronavirus COVID-19 Screening'''" order
+*** [https://www.ahajournals.org/cms/asset/5a965b34-e797-45ed-87a8-f4b71f4dbd6f/cir.0000000000001030.fig08.jpg 2021 AHA ED Chest Pain Testing Algorithm]
-*** 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
+* DHS Eligible
+** '''Low risk (HEART score <3, consider<4)''' - ensure patient goes to Registration Window 6 to finish the Medical application/empanelment process
+** Intermediate to high risk, admit to CORE for further eval (typically CCTA, sometimes nuc test)
+** On the rare occasion you sill feel the need to order the '''CV Treadmill Stress Test''' for "Chest Pain", the order goes to the Heart station and they will schedule the patient.  It is not done by the ED clerk or ED PAC.
+*** Remember, patients should be able to ambulate independently without a cane or walker for about 2 blocks, and make sure the EKG does not have resting ST abnormalities, LBBB, pacing or WPW
+*** If they do not meet these criteria, consult cardiology to determine the best option
+** The Cardiology fellow/attending at the Heart Station will further risk stratify
+*** If deemed low-risk, stress testing will be deferred to the PCP for follow up
+*** If deemed high risk, Cardiology will schedule an alternate non-AGP stress test
+** '''If the stress test is abnormal, Cardiology will arrange f/up for the patient'''
+*** If test is normal, no notification occurs.
+Drs. Chappell & Shah, 5/1/2024
+[[Category:Admin]]