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Heart & Vascular Scheduling Protocol

Elective Procedures

Interventional Cardiology

In accordance with the directives issued by Governor Mike DeWine’s office regarding elective procedure cancellation, the Medical Directors of the Kettering Health Network Heart and Vascular Service Line propose the following guidelines for Cardiac Catheterization scheduling. These guidelines were created after reviewing the recommendations of the American College of Cardiology as well as the criteria issued by Mr. DeWine’s office.

One of the following four criteria should be met and accompanied by physician justification for a procedure to be scheduled in the Cardiac Catheterization Lab:

  1. ST Elevation Myocardial Infarction
  2. Non-ST Elevation Myocardial Infarction
  3. Unstable Angina with Active Ischemia Indications
    1. Abnormal EKG
    2. Ongoing CP
    3. Elevated Cardiac Enzymes
    4. Failed Medical Therapy
  4. Malignant Arrhythmia with Suspicion of Ischemia 

Peripheral Arterial Disease Interventions

In accordance with the directives issued by Governor Mike DeWine’s office regarding elective procedure cancellation, the Medical Directors of the Kettering Health Network Heart and Vascular Service Line propose the following guidelines for scheduling PAD interventions in the Cardiac Catheterization setting. These guidelines were created after reviewing the recommendations of the American College of Cardiology as well as the criteria issued by Mr. DeWine’s office.

The following criteria should be met and accompanied by physician justification for a PAD interventional procedure to be scheduled in the Cardiac Catheterization Lab:

  1. Evidence of critical limb ischemia:
    1. Rutherford Class 5 or 6

Rutherford Class 4 Should is Appropriate to Schedule for In-House Patients

Electrophysiology Procedures

In accordance with the directives issued by Governor Mike DeWine’s office regarding elective procedure cancellation, the Medical Directors of the Kettering Health Network Heart and Vascular Service Line propose the following guidelines for Electrophysiology Lab scheduling.

The following criteria should be met and accompanied by physician justification for an Electrophysiology procedure to be scheduled in the Cardiac Catheterization Lab:

  • Lead Extractions with Septic Shock
  • Lead Extractions for Ongoing Bacteremia Despite Antibiotic Therapy
  • Permanent Pacemaker Generator Changeout for Dependent Patients
  • Permanent Pacemaker Implant for Unstable Complete Heart Blocks
  • Ventricular Tachycardia Ablation for Those in VT Storm

Additionally, the following procedures are appropriate for scheduling based on patient acuity and physician justification:

  1. Permanent Pacemaker Implant for Patients with Long Sinus Pauses and/or High-Grade Heart Blocks
  2. Lead Extractions for Localized Infections
  3. Cardioversions for Afib/Aflutter ONLY if Patient is Severely Symptomatic

SVT Ablations for High Risk Pathways with Evidence of Afib with Rapid-Ventricular Response

Cardiac Rehab

In accordance with the directives issued by Governor Mike DeWine’s office regarding elective procedure cancellation and the closure of recreational facilities, the Medical Directors of the Kettering Health Network Heart and Vascular Service Line propose the following guidelines for patient scheduling in Cardiac Rehab:   

Effectively immediately, Cardiac Rehab will be open to Phase II patients only.

Phase I (in-house) cardiac therapy will continue per norm.

Process for Elective Scheduling

In accordance with the directives issued by Governor Mike DeWine’s office regarding elective procedure cancellation, the Medical Directors and Administration of the KHN Heart and Vascular Service Line propose the following guidelines for scheduling any Cardiac Cath, Electrophysiology, Endovascular, or Structural Heart procedure.

These guidelines were created to offer clarity to the schedulers and front-line staff during the 2020 COVID pandemic. These guidelines were created in accordance with each respective professional medical society as well as the criteria issued by Mr. DeWine’s office.

The following steps will be strictly adhered to until further notice:

  1. Any physician wishing to perform a procedure in a Cath or EP environment must seek approval from that location’s medical director.
    1. A network approved scheduling form is required.
  2. The medical director (or a designee) will approve or disapprove the procedure based on the network-accepted criteria that has been approved for each sub-service line.
    1. Please see the Interventional Cardiology, PAD intervention, Electrophysiology, and Structural Heart scheduling guidelines for the specific criteria.

Please note that these rules apply to outpatient electives only. Inpatient procedures will continue to be performed due to their universally recognized urgent status.

Cath Lab and EP Lab Scheduling Form During COVID-19

March 19, 2020