Harbor:Stress Testing

  • OOP - refer back to in-network PCP for cardio workup


  • DHS empaneled - message PCP for further cardio workup or schedule for stress test
    • 1 - Ensure patient is ambulatory (walk 2 blocks); if not able to complete a treadmill stress test, consult cardiology to determine best option
    • 2 - Send COVID test via "AMB Coronavirus Covid-19" order
      • Select "nasopharyngeal" then modify order
        • Change order for future visit to "no"
        • Change collection priority to "STAT"
      • If the stress test appointment is more than a week in advance, DHS patients can be tested at N26 (the COVID test has to be resulted within 3-7 business days of the procedure)
        • Modify to: "future order"; "RN collect"; "anterior nares"
        • Call x67786 (N-26) with any questions about the COVID testing procedure
    • 3 - Place order for "CV Treadmill Stress Test"
      • Reason for procedure "Chest Pain"
      • Special Instructions "Schedule in 3-4 business days"
      • Outpatient P-MIBI Nuclear stress has to be arranged by CORE
    • 4 - In DEPART section, click "Schedule Follow-up Appointment" so clerk makes appointment prior to patient DC
      • If the COVID test is positive, the Cardiology fellow/attending at the Heart Station will call the patient to discuss
        • 1 - COVID symptoms
          • If asymptomatic for >10 days (or >20 days if severe COVID disease or immunocompromised), the appointment will stand
          • If symptomatic, the appointment will be canceled and the Cardiology fellow/attending at the Heart Station will message the empaneled PCP to ensure close follow-up
        • 2 - Cardiac Symptoms
          • The Cardiology fellow/attending at the Heart Station will call the patient to further risk stratify
            • If deemed high risk, Cardiology will schedule an alternate non-AGP stress test
            • If deemed low-risk, stress testing will be deferred to the PCP for follow up
    • If test is abnormal, cardiology follow up automatically generated by HEART station.
    • If test is normal, no notification occurs, other than typical follow up. If you want someone to follow up on the result, consider messaging empaneled PCP or refer to CCC.


  • DHS Eligible without assigned PCP
    • 1 - Ensure patient is ambulatory(walk 2 blocks); if not able to complete a treadmill stress test, consult cardiology to determine best option
    • 2 - Send COVID test via "AMB Pre-surgical/Procedure Coronavirus COVID-19 Screening" order
      • Select "nasopharyngeal" then modify order
        • Change order for future visit to "no"
        • Change collection priority to "STAT"
    • 3 - Place order for "CV Treadmill Stress Test"
      • Reason for procedure "Chest Pain"
      • Special Instructions "Schedule in 3-4 business days"
      • Outpatient P-MIBI Nuclear stress has to be arranged by CORE
    • 4 - In DEPART section
      • ***CCC for NERF*** (get a PCP assigned)
      • Click "Schedule Follow-up Appointment" so clerk makes appointment prior to patient DC
    • If the COVID test is positive, the Cardiology fellow/attending at the Heart Station will call the patient to discuss
      • 1 - COVID symptoms
        • If asymptomatic for >10 days (or >20 days if severe COVID disease or immunocompromised), the appointment will stand
        • If symptomatic, the appointment will be canceled and the Cardiology fellow/attending at the Heart Station will message the empaneled PCP to ensure close follow-up
      • 2 - Cardiac Symptoms
        • The Cardiology fellow/attending at the Heart Station will call the patient to further risk stratify
          • If deemed high risk, Cardiology will schedule an alternate non-AGP stress test
          • If deemed low-risk, stress testing will be deferred to CCC for follow up
    • If test is abnormal, cardiology follow up automatically generated by HEART station.
    • If test is normal, no notification occurs, other than typical follow up. If you want someone to follow up on the result, consider messaging empaneled PCP or refer to CCC.


Drs. Chappell, Shah, & Pillutla 8/19/2020