Harbor:Stress Testing: Difference between revisions

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


<big><big>* '''72-hour treadmill stress testing is available again''' - Chappell 10/2023 </big></big>
* '''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 [https://www.ahajournals.org/doi/10.1161/CIR.0000000000001030 2021 ACC Chest Pain Testing Guidelines (section 4)]
*** [https://www.ahajournals.org/cms/asset/5a965b34-e797-45ed-87a8-f4b71f4dbd6f/cir.0000000000001030.fig08.jpg 2021 AHA ED Chest Pain Testing Algorithm]


* '''DHS empaneled''' - message PCP for further cardio workup or schedule for stress test
* DHS Eligible
** 1 - '''Ensure patient is ambulatory''' (walk 2 blocks); if not able to complete a treadmill stress test, consult cardiology to determine best option
** '''Low risk (HEART score <3, consider<4)''' - ensure patient goes to Registration Window 6 to finish the Medical application/empanelment process
** 2 - Send COVID test  via "'''AMB Coronavirus Covid-19'''" order
** Intermediate to high risk, admit to CORE for further eval (typically CCTA, sometimes nuc test)
*** Select "nasopharyngeal" then modify order
** 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. 
**** Change order for '''future visit to "no"'''
*** 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
**** Change '''collection priority to "STAT"'''
*** If they do not meet these criteria, consult cardiology to determine the best option
*** 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)  
** The Cardiology fellow/attending at the Heart Station will further risk stratify
****  Modify to:  "future order";  "RN collect"; "anterior nares"
*** If deemed low-risk, stress testing will be deferred to the PCP for follow up
**** Call x67786 (N-26) with any questions about the COVID testing procedure
*** If deemed high risk, Cardiology will schedule an alternate non-AGP stress test
** 3 - Place order for '''"CV Treadmill Stress Test"'''
** '''If the stress test is abnormal, Cardiology will arrange f/up for the patient'''
*** Reason for procedure "Chest Pain"
*** If test is normal, no notification occurs.
*** '''Special Instructions "Schedule in 3-4 business days"'''
*** Outpatient P-MIBI Nuclear stress has to be arranged by CORE
** 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
**'''If test is abnormal, cardiology follow up automatically generated by HEART station.'''  
**If test is normal, no notification occurs, other than typical follow up. If you want someone to follow up on the result, consider messaging empaneled PCP or refer to CCC.


 
Drs. Chappell & Shah, 5/1/2024
* '''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"'''
*** Outpatient P-MIBI Nuclear stress has to be arranged by CORE
** 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
**'''If test is abnormal, cardiology follow up automatically generated by HEART station.'''
**If test is normal, no notification occurs, other than typical follow up. If you want someone to follow up on the result, consider messaging empaneled PCP or refer to CCC.
 
 
Drs. Chappell, Shah, & Pillutla 8/19/2020


[[Category:Admin]]
[[Category:Admin]]

Latest revision as of 21:13, 1 May 2024

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

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