The cardiology unit is growing and now has an intern an accredited registrar as well as a staff of several cardiologists with a range of skills and interests. It currently provides a consultation service as well as a cath lab for diagnostic and elective intervention and a diagnostic cardiology unit (TTE, TOE, stress ECHO, EST, Holter monitor). There is an RMO, registrar and consultant cover during business hours only.
The cardiology bed card will admit any patient requiring CCU including clear cut cardiological problems like STEMI and VT. Less acute cases (NSTEMI, ACS, CCF, AF) are admitted under general medicine and cardiology will provide a consultative service. The medical registrar does the actual admissions after hours in any case. If in doubt call the cardiology registrar in hours or the cardiologist after hours.
Private patients with any cardiological problems will generally be admitted by the cardiologist on call or by their own cardiolgist. Call them and make a plan.
Out of hours telephone consultation regarding difficult or unusual cardiology problems , CCU bed access, scheduling of early angiogram (e.g. next day for very high risk ACS or partially successful thrombolysis) can be made between the ED senior and the cardiologist on call.
Emergency Cath Lab Access
At present the cath lab is open 4 days per week. There is no official emergency service for coronary artery reperfusion. However it is prudent if the cath lab is oen (9-5) to ask if they will perform a hot angiogram as you are preparing to thrombolyse. There has been some successful outcomes with this approach.
Acute coronary syndrome
Low-intermediate risk patients
Best admitted to SSOU for troponin and ECG monitoring and discharged for early outpatient provocative testing (see below)
High Risk Patients
Best admitted under general medicine wth cardiology consult (public patients) or under cardiologist at St John of God (private patients).
See also blog entry on chosing a provocative test.
Privately insured patients
St John of God Cardiac Services offers a chest pain unit during business hours at no cost to the patient.
Call the Chest Pain Centre Hotline 1800 850 133 to speak to the nurse co-ordinator.
Essentially they are able to offer everything from ECG to angiogram as appropriate to the patient. There is no need to book a bed when referring low to intermediate risk patients for this service as the majority will be risk stratified sufficiently to discharge home (occasionally a patient with a positive work up may need to come back to the public hospital at the end of the day if no bed can be found at the private by that time).
There are a number of options.
Bendigo radiology is technically able to offer coronary CT angiogram however its place in chest pain workup is not yet settled and it is not medicare funded in Australia which limits it use considerably. For the time being Coronary CT Angio should not be considered for patients in Bendigo.
St John of God can generally bulk bill for Exercise Stress Tests ordered for outpatients and the waiting list is short.
The Bendigo Health Care Group Diagnostic Cardiology service generally has a long waiting list for exercise stress test and ECHO but it is always worth a phone call as cancellations are not uncommon and frequently provocative testing is available from the SSOU if the effort is made to seek it.
Stress ECHOs are performed both at the private with an out of pocket cost after medicare rebate (like any out of hospital test) and at the public (with a longer wait but no cost). The public hospital performs a structural (resting) ECHO first and then books the patient to come back for a stress ECHO which adds to the time delay.
ECHO, Holter monitor, PPM check and cardiology consultation are generally available during business hours. Outside business hours private patients can always be referred to the cardiologist on call.