Cardiac Consult Protocols


heart_doctor_150 Cardiology Fellows on the General Consult Service are expected to follow these protocols:

Consults

Catheterizations
Conferences
Covering the UH CCU Cardiology


Consults

  1. Requesting physicians should be directed to phone in routine consultations to the Cardiology Fellow on the consult service via the UAB Paging Operator (4-3411).
  2. Routine consultations should be answered within 24 hours after receipt. Consultation requests received on Friday should be answered on the chart by Saturday.
  3. All consult patients shall be presented to the Consult Service Attending Physician.
  4. Emergency consultations, whether received during regular hours, after hours, or on weekends, will be answered promptly. The attending physician on call should be made aware of all emergency consults immediately after the consult is answered. The patient may be seen by the attending on call, if appropriate. If not seen the same night, the consult will be seen by the consult attending the following day.
  5. Rounds are ordinarily conducted daily, Monday through Sunday at a time designated by the attending physician.
  6. Since the Consult Service is an educational and a service unit, all patients should be seen initially by a medicine resident or medical student assigned to the Consult Service whenever feasible. The Cardiology Fellow is to use his/her discretion in this regard in the case of acutely ill patients in need of immediate attention. At Cooper Green Hospital, the Cardiology Fellow is responsible for seeing all consults and to staff all consults with the consult attending.
  7. The Cardiology Division is committed to excellence of practical patient care as well as academic excellence. While all aspects of a patient are of interest, consult notes should always:
    1. Answer the specific questions asked
    2. Be brief and to the point while conforming to all documentation requirements as delineated in the Medicare guidelines.
    3. Be tactful Communications with the off-service residents and off-service attendings should be timely and similarly tactful.
  8. For the purpose of records, the medicine resident and/or Cardiology Fellow will complete a BLUE CONSULT SHEET immediately after seeing each patient in consultation; note that a complete review of systems is mandatory (pre-printed ROS sheets are available on 6-South). The Cardiology Attending Physician will write a detailed consult note documenting his/her findings and recommendations. This note will be coded for billing purposes. Selected attendings choose to use PDA’s to generate their notes and may give additional instructions to the housestaff and Cardiology Fellow to assure completeness of documentation.
  9. The Cardiology attending physician, Cardiology Fellow, Internal Medicine Resident, and students will document all of their visits to patients with a written note. For billing purposes, it is important for the Cardiology attending to label all progress and consult notes according to the level of intensity. Current Medicare guidelines do not allow Cardiology Fellows to bill, but, since an understanding of appropriate billing is an important part of any training program, Cardiology Fellows are encouraged to discuss note coding and billing with the attending physicians.
  10. Procedures on consult patients are generally performed in the special
    cardiology laboratories such as the echocardiography laboratory, the nuclear medicine laboratory, and the catheterization laboratory. Procedures performed by the consult team should be documented by appropriate procedure notes.

Catheterizations of Patients on the Consult Service

The Cardiology Fellow assigned to the consult service is responsible for scheduling cardiac catheterization procedures on consult patients between 8 AM and 5 PM. After hours, the consult resident should contact the Cardiology Fellow assigned to the UAB cardiac catheterization laboratory to add the patient to the schedule. The Cardiology Fellow assigned to the Consult Service may choose to perform the cardiac catheterizations on patients who he/she has previously evaluated, provided that the procedure does not interfere with consult rounds or duties at CGH.

Conferences

Cardiology Fellows, housestaff, and students on the Consult Service are responsible for attending the teaching conferences.


Covering the UH CCU

Covering the UH CCU Cardiology Fellow in Clinic: Cardiology Fellows assigned to the UH Consult Service will cover procedures and ED consultations for the UH CCU Cardiology Fellow on afternoons, when the latter is assigned to BVAMC or TKC clinic or will make alternate coverage arrangements, if unavailable due to duties on the consult service. The Chief Fellow should be contacted in case of cross-coverage questions.
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