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Cardiology

CARDIOLOGY- HOSPITALIST Co-Management Model/ Anderson Team 3

Type of patients: - Stable ACS patients and arrhythmia patients - Decompensated heart failure patients (“warm” and “wet”) - Stable endocarditis patients - Post structural interventions- s/p MitraClip, PBMV, etc. - CICU patients that are downgraded - Type II myocardial injury/ infarct patients in the setting of other non-cardiac primary presentation - Atrial fibrillation patients in the setting of other non-cardiac primary presentation *These patients can be admitted to Cardiology Team 3 or the Hospitalist Med H service- discretion of the hospitalist. Primary staffing: Hospitalist (Magnolia as primary). Standing cardiology consult on ALL patients (Floor Team 3). Co-managed by the cardiology consult attending and consult fellow. The cardiology team can place orders directly. Admit Process: - Identification of patients appropriate for co-management: - Post-procedure patients: Procedure fellow informs MAO. - Appropriate CICU downgrades: CICU fellow/ resident informs MAO. - ED patients: Through MAO per criteria above. MAO can discuss case with the cardiology fellow and admitter, as needed. - Hospitalist completes admission orders and H&P. ADT1 with Hospitalist Co-Management as primary team. Once admitted, assign Magnolia and Cardiology Team 3 (C3) as treatment teams. Leave Co-Management as primary. - Consult fellow to leave consult note- same day or next day for overnight admissions. Place orders as appropriate.

  • Co-Management Expectations
  • Both teams round in AM. Once consult team is finished rounding, the consult team ‘runs the list’ by phone with co-management provider with clear emphasis on new recommendations, orders, and action items.
  • Both services will review orders daily.
  • Both services evaluate patient in person during rapid responses and acute deterioration.
  • Consult team places orders for specialty-specific recommendations.
  • Please designate section of recommendations within consult note to clearly itemize new recommendations and which orders are being placed by the consult team.
  • Indicate if a lab or radiology study may require more urgent follow-up and action overnight so that we can communicate this with our covering providers.
  • Consult providers should NOT order electrolyte replacement for patients.
  • Nursing is expected to direct all cross-cover issues and questions to hospitalist provider.
  • When patients approach discharge, the consult team outlines discharge medication recommendations within consult note. Hospitalist ultimately responsible for discharge med reconciliation and scripts. Disposition:
  • Unless consult team feels it necessary, would generally not transfer from Magnolia to Anderson team 1 and 2 (teaching teams).
  • Magnolia will not continue to follow patients needing upgrade to CICU.
  • For discharge, hospitalist does med reconciliation, hospital course, discharge summary. Cardiology fellow to facilitate follow-up for cardiology.