D.35 Abnormal Test Results.pdf
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- Attached to
- Q201--Ada CBOC
- Solicitation number
- 36C25923R0047
About this file
This document outlines a critical results reporting policy for the Oklahoma City VA Health Care System. The policy defines critical test results that require immediate notification of physicians, including positive findings of new thrombus, cardiac tamponade from echocardiograms, severely reduced ventricular function from echos or EKGs, unstable angina or arrhythmias from stress tests, and new arrhythmias or pacemaker failures from Holter monitoring or EKGs. The policy mandates notification of ordering providers or on-call cardiologists for inpatients or retaining outpatients for evaluation. It specifies response windows of 5 to 30 minutes for life-threatening EKG findings and 1 hour for other critical echocardiogram or EKG results. The policy is signed by the Chief of Cardiology and scheduled for recertification every five years.
The related federal contract opportunity is for the Ada CBOC located in Oklahoma under the Veterans Health Administration VISN 19. No further information is provided on the requirements, response dates or value of the contract.
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Abnormal Test Results: CRITICAL RESULTS reportinq policy
SOP 303-02
Oklahoma City VA Health Care System Oklahoma City, Ok 73104
Signatory Authority:
Venkata Chilakapati, MD
Responsible Owner:
Venkata Chilakapati, MD
Service Line(s):
Medicine-Cardiology
Effective Date:
January 7, 2021
Recertification Date:
January 7, 2026
(A) Policy Statement: The Heart Station technologist or nurse will notify the Cardiology fellow or the designated attending cardiologist in the lab (OR on call). MDs will call the Registered Nurse or MD in charge of the patient when a critical result is noted during or after a heart and vascular procedure.
(B) Purpose of Policy: To allow for prompt identification and patient care management necessary for treatment of life-threatening conditions.
(C) Procedure: During or following a procedure, if a life-threatening result is noted, the nurse or technologist will immediately initiate the following:
1. Inpatients: notify the cardiology fellow or designated cardiologist in the lab (OR on call). MDs will call the Registered Nurse or MD in charge of the patient when a critical result is noted during or after a heart and vascular procedure. For inpatients who have been brought to the department for testing; if the patient's condition and time permits, the patient should immediately be returned to their room or the Emergency department (if different acuity level of care is required).
2. Outpatients:. retain the patient, if possible, and notify the Cardiology Fellow or the designated attending cardiologist in the lab (OR on call). MDs will call the Registered Nurse or Ordering provider or MD in charge of the patient when a critical result is noted during or after a heart and vascular procedure. If the patient's physician's office is closed, the attending on Cardiologist should evaluate the patient and arrange a cardiology consult appointment in the office.
If the patient refuses to wait, attempts to notify the patient's physician must continue until successful.
3. If medical or nursing care is needed, it may be initiated by RN, Cardiology fellows, residents or attending physicians. If care is initiated all efforts should be made to transport the patient to a patient room or the Emergency Department as soon as possible.
4. Critical test result is defined as:
Abnormal Test Results: CRITICAL RESULTS reportinq policy
ECHO:
> A positive finding of a new thrombus/ new mass/ vegetation in the heart found during a routine echo/TEE, within 30 minutes.
> A large pericardial effusion or evidence of cardiac tamponade found during a routine echo, within 30 minutes.
> New onset, severely reduced right or left ventricular systolic function, within 1-hour.
> New onset, severely enlarged right ventricle, suspicion of Pulmonary embolus, notify within 30 minutes.
> Severe/critical, unknown aortic or mitral stenosis notify within 1 hour.
STRESS:
> New ischemia with unstable angina, within 15-30 minutes.
> Unstable arrhythmias within 15-30 minutes.
HOLTER:
New arrhythmia noted when scanning a Holter or interpreting event recorder rhythm strips, within 1-hour of scanning. Arrhythmias are defined for this purpose as:
> Narrow complex tachycardia greater than 150 beats per minute for greater than 30 seconds.
> Pauses greater than 3 seconds.
> Second Type II and third-degree heart block.
> Pacemaker failure > Wide complex tachycardia of 200 beats or greater with a duration of 4 beats or more.
> Wide complex tachycardia of 160 beats or greater with a duration of 20 beats or more.
EKG:
Immediate notification within 5-10 minutes:
> New ST segment elevation 1 m or more in two contiguous leads on 12 lead
EKG.
> New ST segment depression of 2mm or more in two contiguous leads on 12 lead
EKG.
> Heart rate less than 30 beats per minute for any reason on EKG.
> Sustained ventricular tachycardia, and /or torsade de pointe on EKG.
> Narrow complex tachycardia greater than 150 beats per minute for greater than
30 seconds.
> Pauses greater than 3 seconds.
> Second Type II and third-degree heart block.
> Pacemaker failure
Abnormal Test Results: CRITICAL RESULTS reportinci policy
5. Document critical results reporting in CPRS and also mention at the end of test report.
6. REVIEW
Chief of Cardiology will review at a minimum of every three years or when there are changes to the governing documents published by the above listed references.
7. RECERTIFICATION
This SOP is scheduled for recertification on or before the last working day of January 7, 2026. In the event of contradiction with national policy, the national policy supersedes and controls.
8. SIGNATORY AUTHORITY
VehJ(ata Chilakapati, M Chief of Cardiology Section
NOTE: The signature remains valid until rescinded by an appropriate administrative action.
DISTRIBUTION:
SOPs are available at:
https ://dvagov.sharepoi nt.com/siteslokl/Memos/Lists/Medicine/darrell%205.aspx
File details come from the government source that posted it. Updated .