ekgs in pre-operative management for osh transfers
TRANSCRIPT
![Page 1: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/1.jpg)
EKGs in pre-operative management for OSH transfers
![Page 2: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/2.jpg)
Assess if EKG’s are ordered appropriately on patients who are transferred from OSH to undergo Dr. John Lee endoscopic procedures
![Page 3: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/3.jpg)
When to order an EKG
![Page 4: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/4.jpg)
ACC/AHA recommends preoperative EKG in patients at least one clinical risk factor scheduled to
undergo vascular surgery patients scheduled to undergo intermediate-risk
surgery with known cardiovascular disease, peripheral artery disease, or cerebrovascular disease
They do not recommend preoperative EKGs in asymptomatic patients undergoing low-risk surgical procedures.
There is a recommendations for further work up on any patient with symptomatic heart disease
![Page 5: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/5.jpg)
Thus any asymptomatic patient that is transferred for an endoscopic procedure does not warrant a pre-operative EKG
However, if a patient shows symptoms of ACS, CAD, CHF, or arrhythmia getting an EKG would be appropriate
![Page 6: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/6.jpg)
![Page 7: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/7.jpg)
Patient’s were all transferred from an OSH for a potential procedure to be done by Dr. Lee.
10 total patients Male = 3 Females =7 Patients selected from the online Hospitalist
Transfer Webpage. Patients were the last 10 John Lee acceptances as of 4/16/13. Admission occurred over the course of 1 month
Inclusion criteria is acceptance of patient by Dr. Lee. Exclusion criteria was any patient who did not have an endoscopy preformed
![Page 8: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/8.jpg)
Information regarding the patient’s stay was obtained from a retrospective search of the patient's online chart and orders from that hospitalization.
EKG appropriateness was determined as per the above descriptors. All EKGs for endoscopic procedures of
asymptomatic patients were deemed inappropriate All EKG’s preformed for any symptomatic heart
disease was also deemed appropriate Those patient’s who did not require and EKG
and did not receive an EKG were also noted to be appropriate Pre-Operative management
![Page 9: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/9.jpg)
9/10 patients underwent endoscopic procedure
1 patient was found not to be a candidate for an endoscopic procedure on transfer and underwent surgical management by Gyn/Onc
![Page 10: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/10.jpg)
In total 8/9 pts had EKG’s ordered after transfer.
Of those 8 pt’s, 2 EKGs were appropriately ordered for pre-operative reasons Pt showing signs of symptomatic
tachycardia/heart failure Pt with abdominal pain and recent hx of meth
use Of the 6 ordered incorrectly 2 were ordered
by anesthesiology (33%). The remaining 4 were ordered by medicine (66%)
![Page 11: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/11.jpg)
In total 4/9 patients received appropriate pre-operative EKG management 2 appropriately ordered and 2
appropriately not ordered
![Page 12: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/12.jpg)
![Page 13: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/13.jpg)
EKG pre-operative management was done inappropriately in 56% of studied cases per the ACC/AHA guidelines.
![Page 14: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/14.jpg)
It’s hard to say… The study was retrospective/cross-sectional and
those physicians who ordered the EKG’s were not surveyed as to why they ordered EKG was ordered.
A future study that surveyed these physicians would be a more informative study.
…but if you ask me Pressure to make sure patient’s aren’t delayed
for procedures Pressure from anesthesia to obtain these EKG’s
regardless of indications Education/Culture of both anesthesia and
medicine
![Page 15: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/15.jpg)
Medicare reimbursement = $68 / EKG interpreted
# of incorrectly ordered EKG’s over 4 weeks: 6
Assuming accurate cross-section Average cost: $408/mo $4,896 of Medicare
waste per year on one subset of patients.
![Page 16: EKGs in pre-operative management for OSH transfers](https://reader035.vdocuments.net/reader035/viewer/2022062321/56649e605503460f94b5b2ab/html5/thumbnails/16.jpg)
Increasing anesthesia and medicine interaction regarding pre-op Pre-Op Clinic together Joint lectures
Pre-Op order set