Adult Cardiology
11th Floor POB

Adult Cardiology at RUMC
• Treat a variety of congenital and chronic cardiac conditions – Range in acuity • Has 8 specialized programs that focus on disease and prevention • Ranked 21st in the nation by U.S. News and World Report

Clinical Staff
• 20 Cardiology M.D.s at Rush – 2 Cardiology M.D.s at Rush Oak Park Hospital • 1 Nurse Practitioner • 2 Check-In Clinic Coordinators • 3 Discharge Clinic Coordinators • 5 Certified Medical Assistants • 2 Call Center Coordinators • 3 Registered Nurses – Coumadin Clinic – Phone Triage

Physician Education

• Medical Degree or Doctor of Osteopathic Medicine • Residency in Internal Medicine
– 3 years

• Cardiology Fellowship Training
– 3-4 years per ACGME guidelines

4

Outpatient Clinic Volumes
• On average the clinic will see between 115-140 per day • Staffed with 5-7 Attending seeing patients per day • Roughly a patient volume of 29,000 outpatient visits per year
– Monday-Thursday: 115-150 patients – Friday: 80 patients

Outpatient Check-In
Patients are greeted by two Clinic Coordinators • Verify patients appointment by asking for their name and date of birth • Scan a copy of patients insurance card • If the patient has not verified their insurance with hospital Registration prior to appointment, they would do so at this time • Patient is called to their clinic room by Medical Assistant

Check-Out
Cardiology utilizes 3-4 Clinic Coordinators who check out patients following their appointments • Responsible for scheduling future appointments • Schedules all diagnostic procedures • Pre-authorize all diagnostic procedures
– Ex: Stress test, EKG, angiograms – Each coordinator is responsible for tracking and getting authorization for patients who stop by their booth at check out

Patient Flow from MA’s Perspective

• Patient ready to be brought into exam room • Write Pt’s initials on whiteboard • Bring Pt into Exam Room
– After finishing the check-in process

• Put status to “green”

– Change status to “yellow” – Check vitals and make sure all other Pt information is correct – Input into EPIC
– Pt ready for physician

Patient Flow from MA’s Perspective

• After visiting with physician
– Patient sent to either get blood work, EKG or check-out

• Check-out
– Patient status changed on EPIC to “red”

Patient Flow
• Things MA’s check for:
– Vitals (i.e. Blood pressure) – Weight – Medications – Pharmacy patient uses

Patient Flow
• Flag System
– Same as EPIC dot color system – Replaced by technology

• Less personal communication between MA’s and physicians
– Everything is done over EPIC – Too much time spent looking at computer screen

In Office Lab
• Medical Assistants conduct blood draws. • Collect vials for physician ordered tests or do a finger stick for Coumadin level check.

• Responsible for entering requests for prescription refills for RN’s – Completely Electronic

12

Maricella – Medical Assistant
• Constantly monitoring EPIC for patient status • Preparing supplies before patient enters room • Chatting and joking with patients to make them comfortable • A majority of work completed on EPIC

13

Coumadin Clinic
• Used in patients at risk for blood clots • Patients come every 2-4 weeks, depending on their case

• Works similar to a Glucometer, but measures Blood Clotting tendency – INR Level
14

Coumadin Levels
• Range 2-3  Good • After result, nurses will consult patients.
– Nutrition
• Vitamin K (Leafy Greens)

– Missed Doses

• Decide if changes need to be made to dose and when patients need to return for next level check

15

Compliance
• Coumadin monitoring is extremely important. – Bleeding/Clot Risk • Epic will alert clinicians to patients who need follow-up, and medical assistants will contact noncompliant patients. • Follow-up via phone and, if necessary, certified mail.

16

Nurses in Adult Cardiology • 3 RNs manage Anticoagulation Clinic
– One Nurse Practitioner for 20 physicians

• Education Required
– Licensed RN – Basic Life Support (BLS) certification – Anticoagulation Management certification w/in 1 yr – Advanced Cardiac Life Support (ACLS) preferred

RN Work Flow
• Phone operators field calls from patients and their families • Messages sent to nurses through EPIC • Nurses follow up and make a record in EPIC • Documentation is very important —Medication adjustments —Open and closed encounters

Heart Failure Patients
• 2 Heart Failure Physicians
– VAD Machine = Ventricular Assist Device – Patient’s awaiting transplants – Keeps the heart functioning – Checks status and function of device

Atrial Fibrillation Disease Process
• Patient feels symptoms

• ER, Primary Point of Referral, sends patient to cardiologist • Medical history and associated factors questioned

- palpitations, shortness of breath, chest pain, fatigue

CHADS2 SCORE
• Chances of stroke • Anticoagulation Therapy - Coumadin (Warfarin)

Testing Procedures

• Electrocardiogram (ECG) • Echocardiogram (ECHO) • Lab Tests - blood cell count
- sodium and potassium levels
- thyroid (hyperthyroidism)

Echocardiogram Test

Treatments
• Medicines • Control rate (Beta Blockers) • Control rhythm • Procedures • Electrocardioversion • Cardiac Ablation • Therapy - Coumadin (Warfarin) Electrocardioversion

Alternative Measures

• -

Underlying Causes treatment of overactive thyroid lower high blood pressure manage high cholesterol

• Manage lifestyle - healthy diet - quit smoking - avoid alcohol and caffeine

Questions?

25