GENERAL PREAMBLE
EP1 is designated for device implants. However, there will often be add-on device implants for inpatients if the EP cases finish with sufficient time remaining.
Patients should be consented prior to arriving at the EP lab, where possible.
Select the 'Preprocedure' button on the left
Select 'Consents'
Select 'New Verbal Consent COVID'
Document consent details, as well as person obtaining consent and witness.
Make sure you e-sign the document (you can ignore the sections about tissue for research).
PPM: Death 1/5000, Punctured Heart 1/500, Punctured Lung 1/200, Infection 2-3%, Bleeding or major bruising 2-3%, Lead Dislodgement 3%, Device Malfunction Rare
ICD: Death 1/4000, Punctured Heart 1/1000, Punctured Lung 1/200, Infection 1-2%, Bleeding or major bruising 2-3%, Lead Dislodgement 2-3%, Device Malfunction 1-5%, Inappropriate shock(s)~20%
CRTD: Risks: Death 1/1000, Punctured Heart 1/1000, Punctured Lung 1/200, Kidney Failure 1%, Infection 2-3%, Bleeding or major bruising 2-3%, Lead Dislodgement 5-6%, Device Malfunction 1-5%, Inappropriate shock(s) ~20%
Step by Step
Ask for help from Billing Dept (Michelle Gaudreau MGaudreau@ottawaheart.ca) to set up preferences
Select the patient from the Status Board
Select 'Charges' from left bar
Select appropriate code(s)
In 'Dx' column, ensure circles are red + blue and linked (not grey and separated). If the latter, click it and select the appropriate diagnosis to link.
Click on the charge and input a start + end time.
Click 'Accept Charges' button.
Trouble Shooting
Make sure you are in the appropriate 'job' to bill (must be Resident/Fellow Physician'
If you don't see 'Charges', check 'More' at the bottom on the left bar.
You can check to see if the billing went through by checking a 'Billing Report':
Ensure you are in the 'Physician' Job type
Click the 'EPIC' button in the top left.
Select 'My Reports'
Select 'Library'
Select 'ATL Pilot Provider Charges'
Click 'Edit' ton provide date parameters (and any other settings wanted)
Click 'Run'
GENERAL PREAMBLE
There is always a Staff and Fellow assigned to Device Clinic each day. Unless otherwise specified, the Staff and Fellow on Clinical Service are covering the Device Clinic.
On Mondays, a Staff and Fellow other than those assigned to Clinical Service typically will cover the Device Clinic (giving the team on Clinical Service a chance to catch up from the weekend). This is generally the Fellow on Clinical Service the prior week.
In general, ICDs/CRTs/new implants are booked more heavily in the mornings, and pacemakers booked more in the afternoons.
There are 4-5 rooms with nurses running at a time. Each day a specific senior nurse is assigned as 'charge' to deal with remote monitors, coordinate the other nurses, and deal with general issues. They will come to you or the staff on service as necessary.
Patients are booked starting at 8am, and typically nurses are ready to start reviewing at 8:15am. (Wednesdays and Fridays may start to have a later start to accommodate Grand Rounds and EGM Rounds). There is a 'lunch break' between noon-1pm. Usually, device clinic wraps up close to 4pm.
You do not need to write a note for every patient seen. Only write a note if there is relevant information to have available for future device clinic visits or if there is something to be communicated to other physicians. Often notes are written during downtime between patients/lunch and after clinic is finished as the clinic can be quite busy.
Help line: 1-800-722-3278 (account # 1168)
For access, ask the device nurses to create an account for you.
To access, go to https://clc.medtroniccarelink.net/Clinician/Login/login.aspx?ReturnUrl=%2fClinician%2f (create a desktop shortcut for yourself to save time)
Medtronic Canada line for physicians: 1-800-217-1617
Boston Scientific: 1-800-227-3422
St. Jude: 1-800-722-3774
Select the 'Preprocedure' button on the left
Select 'Consents'
Select 'New Verbal Consent COVID'
Document consent details, as well as person obtaining consent and witness.
Make sure you e-sign the document (top 2 signatures; you can ignore the lower sections about tissue for research).
SVT: Death 1/5000, Stroke 1/3000, Heart Attack 1/3000, Heart Block requiring Pacemaker 1/500, Punctured Heart 1/500, Leg Vein Thrombosis 1/1000, Lung Thrombosis 1/1000, Leg Bruising 2-3%, Damage to Leg Blood Vessels 1/200
Afib: Death 1.5/1000, Stroke 2.3/1000, TIA 7.1/1000, Cardiac Tamponade 13.1/1000, Vascular Access Related Issues 14.7/1000, Pulmonary Vein Stenosis 2.9/1000, Diaphragmatic Paralysis 1.7/1000, Atrio-esophageal fistula 0.4/1000
To review cases: open program 'Mac-Lab Cardiolab' (icon shows computer screen in front of grey heart)
Select patient from list (search by name, date, or MRN)
Click 'Review Case' on left
To annotate, click the camera icon on the toolbar
In order to be able to adjust signal amplitude for saving images/printing, you must use the righthand screen.
Note: the program does randomly crash on occasion due to a lost connection to the server. Reopen the program when this happens.
To return to an active study, select patient name and click 'Continue Study'
To save new CARTO images:
Select Review Study
Find patient name
Select file
Right click on dropdown bar at top and change to desired map (usually Bipolar)
Right click on 'Bi' at top left to change voltage settings
To move image, click with mouse wheel or use arrow keys and Home/End keys
Right click small blue squares at top right and choose 'Hide Plane' as needed to remove unneeded screens
Left click down arrow next to camera icon and select Preferences
In 'Preferences', choose 'Region' ('Window' is just left monitor, 'Full' is everything)
Click on the camera icon, and use white background to select area of interest
Save under chosen file name
To download saved CARTO images:
Insert USB in to computer in back room or next to CARTO computer
In CARTO, select System -> Export Data
Find patient name
Select files you want
Click arrow on right
Deselect Encryption
Select USB
Click Export (if greyed out, select and deselect 'Data Encryption' again)
To access old CARTO cases on hard drive/from CD and move to current computer:
If from CD, insert CD in backroom computer
In CARTO, select 'Study Archiver' and choose 'Restore'
On left, choose where to Restore from CD/DVD vs USB (hard drive)
Select patient name and select arrow on right for chosen files
Colourful hearts are CARTO, black and white hearts are CT images
Click 'Restore' on bottom right
Files are now on current computer
On your outpatient clinic weeks, please arrange one of those clinics daily by contacting the staff:
Inherited Arrhythmia Clinic with Dr. Green(Fridays)
Cardiac Sarcoidosis Clinic with Dr. Birnie (Fridays)
Arrhythmia Clinic with Dr. Sadek (Wednesdays)
EP Clinic with individual EP staff
AF Clinic with individual EP staff