Invasive+cardiology+procedures

=Cardiology Procedures Referral and Inpatient/Outpatient Telephone Consultation=

Cardiology Transfers - The quick guide:
Transfers are regional and insurance-based transfer:
 * West County non-MediCal AND all MediCal to DMC (aka East Bay Cardiology) 510-233-9300
 * Central & East Counties only non-MediCal go to John Muir (aka Contra Costa Cardiology) 925-671-0610

//Central or East County patients (without MediCal)//

 * Patients should go to John Muir Concord Campus. First call **Contra Costa Cardiology** group and ask for the physician on call, at 925-671-0610. Nursing needs to know a catheterization, pacer, etc. is planned, to contact social work for transportation and the discharge planner for CCHP approval.
 * Contra Costa Cardiology group can also provide telephone consultations even if the patient is not referred for a procedure
 * For a central or east county patient with MediCal, you cannot send them to John Muir Concord. The patient needs to go to Doctor's San Pablo (see below).

//West County patients (all) and Central/East County patients with MediCal//
__Mon, Tues, Thurs, Fri (7AM-5PM)__
 * These patients should be referred to **East Bay Cardiology** (Doctors Hospital), Drs. Arnold and Weiland are serving as the main contacts through the group. Telephone consultations can also be provided even if the patient is not referred for a procedure. Protocol is as follows:

 1 st Call = Arnold: (cell phone in Meditech, go to "library", #27 "Cardiology", "ref for invasive procedures" -- alternatively can call office)  2 nd call = Weiland (cell phone in Meditech, go to "library", #27 "Cardiology", "ref for invasive procedures" -- alternatively can call office)  3 rd call = East Bay Cardiology 510-233-9300 (office)

 __Wednesday (7AM-5PM)__

 1 st call = Weiland (cell phone in Meditech, go to "library", #27 "Cardiology", "ref for invasive procedures" -- alternatively can call office)  2 nd call = East Bay cardiology 510-233-9300 (office)

 __Nights 5pm-7am, weekends__---call East Bay Cardiology 510-233-9300 (office, answering service)  Please read above regarding transportation and financial approval.

UCSF Cardiology

 * CCRMC no longer has a contract with UCSF so routine cases should not be referred to them.

Things to do prior to a catheterization

 * Labs: PT/PTT, creatinine, CBC
 * If patient has obstructive sleep apnea, or if you suspect sleep apnea, alert the cardiologist so they are aware with sedation
 * Enoxaparin (Lovenox) must be held the morning of catheterization
 * The patient should understand the procedure in general terms and agree to the procedure before being sent (formal consent not required)

· Appropriateness for angiography should be determined by cardiology consult or discussion with a medicine attending.
When referring to cardiology clinic, please have ALL appropriate basic tests ordered, including EKG and echo, thallium or holter or event monitor (dependent upon what is deemed necessary). (Last updated by Oliver Graham, October 2009)
 * See the guidelines on referral to [|cardiology clinic].
 * If a procedure is in order after the patient is seen by Cardiology, then the Cardiologist will arrange for a referral via our patient care coordinator, Tamara Angel, at 925-370-5988. Please call her with questions about procedures such as cardiac catheterization.
 * As the primary physician, you are expected to follow the patient post-procedure (along with Cardiology if indicated).
 * Outpatient authorizations are obtained through CCHP at 957-7260.