Andrew Hresko, Cardiovascular Roundtable
We often receive questions from our members about how to optimally design on-call coverage plans for CV physicians. For several years now, hospitals have struggled to provide adequate specialist coverage in the ED, including for cardiology. In the past, hospitals required physicians to take call in exchange for medical staff privileges, but this arrangement has become less appealing to physicians. Many intuitions now feel the need to provide physicians with supplemental compensation as an incentive for providing call coverage.
To address this persistent issue with cardiology in mind, we’ve answered several frequently asked questions about call coverage strategies below, and provided links to the Advisory Board’s best resources on specialist call coverage.
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Megan Tooley, Cardiovascular Roundtable
As previously discussed in Cardiovascular Rounds, a number of recent studies have evaluated the overall costs and downstream impact of coronary CT angiography (CCTA) in various patient populations.
Adding to this list is the ROMICAT II (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial. The study assessed if using CCTA as a first diagnostic test in the emergency department (ED) to rule out acute coronary syndrome (ACS) in low-to-intermediate risk patients is more effective than standard evaluation.
The trial results, published in the New England Journal of Medicine on July 26, further validate the utility of CCTA as a safe alternative to nuclear imaging for certain patients presenting to the ED with chest pain. While overall costs, including all subsequent downstream services, were modestly higher in the CCTA group on average, the efficiency gains from a CCTA-based diagnostic strategy are promising.
Overall, more patients were discharged from the ED with fewer admissions to an observation unit among those receiving CCTA compared to standard evaluation.
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The results of the highly anticipated CT-STAT trial were released this week in the Journal of the American College of Cardiology. The study objective was to compare the efficiency, cost, and safety of coronary CT angiography to rest-stress myocardial perfusion imaging to diagnose coronary artery disease (CAD) for emergent low-risk patients. Overall, CCTA was found to be more efficient and less costly than traditional SPECT imaging in the diagnostic work-up of this patient subset. While helping to further validate the role of CCTA to expedite care for appropriate chest pain patients, the study raises new questions about future opportunities for CCTA, and if it can supplant more established tests for diagnosing and ruling-out CAD.
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