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Cardiology-FM IPS admission and consult guidlines

Page history last edited by gabrielpalley 6 months ago

Preliminary Protocols for

Admission/Consult Guidelines for DFCM IPS and Cardiology Consult

(formal Service Line Agreement is in process and should be released by August 2021)

 

(Please note the Bolded diagnosis and Consult Requirements below)

 

  1. The DFCM IPS service will admit all patients with a primary admitting diagnosis of a cardiovascular illness, including:

    1. Congestive Heart Failure

      1. For patients with New Diagnosis of, or acute exacerbations of chronic, heart failure (HFrEF, HFbEF, HFpEF).

    2. Symptomatic Arrhythmia

      1. Family m=Medicine will consult Cardiology/EP for SVT (AVRT & AVNRT) as well as A-Flutter patients

      2. Family Medicine may consult Cardiology for 

    3. Acute Coronary Syndrome 

      1. Family Medicine will admit and manage unstable angina and NSTEMI, and will consult Cardiology for all of these patients.

      2. Cardiology with admit all STEMI 

    4. Unexplained Syncope 

 

  1. The inpatient cardiology service will admit any patient with a primary admitting diagnosis of Hypertensive Emergency with Cardiac End Organ Damage as well as Pulmonary HTN 

 

  1. When a patient is considered for hospital admission, the admitting Family Medicine IPS resident will be contacted for evaluation. If there is uncertainty in the nature or severity of the cardiovascular condition, the cardiology attending or fellow will decide the appropriateness of admission.

 

  1. Family Medicine Patients should be preferentially admitted to 3-North, even with Cardiovascular diagnoses. 

 

  1. Patients with hemodynamic instability in the contexts of myocardial infarction, primary myocardial disease, or valvular heart disease may be candidates for admission to CT ICU (6-8 beds).  This includes patients needing LC Assist Devices including the Impella device to support high risk PCI, those under consideration for cardiac transplantation, those who are candidates for ECMO, those in cardiogenic shock requiring pressor and/or IABP support, and those with complex congenital heart disease in need of urgent intervention. The management of these patients admitted to the unit by DOIM Cardiology will be provided jointly by a cardiology faculty attending and a CT surgery faculty attending in most cases; cardiac anesthesiology/critical care may also participate in the management of these patients as required. 

 

  1. Transfer between services:

    1. Transfers between services should be coordinated at the attending level.

    2. Appropriate transfers from Cardiology to Family Medicine include:

      1. Patient with an ongoing active medical issue

      2. Patients require a lengthy hospital stay. These transfers should be discussed attending to attending on a per-patient basis, taking into account respective service workloads,

      3. Transfers of care are to be accompanied by a problem-based interim summary AND a verbal signout. The primary team shall remain responsible for the patient until transfer orders are written. 

 

  1. Consults:

    1. Family Medicine will consult cardiology on all patients: 

      1. New Diagnosis of, or acute exacerbations of chronic, heart failure (HFrEF, HFbEF, HFpEF)

      2. Symptomatic Arrhythmias

      3. ACS (unstable angina and NSTEMI)

      4. Worsening chronic CAD/Heart Failure without recent/adequate ischemic work-up

 

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