Heartfelt with Dr Melissa Walton-ShirleyView all posts »
TIMACS-another reason to be on time to the office.Nov 11, 2008 00:54 EST
A typical scenario in the day in the life of a busy cardiologist:
You arrive to the hospital with plenty of time to see everyone on your rounding list. You are fairly refreshed because you weren't on call last night. You rush at first, but then seeing you have about thirty minutes before you have to be at the office, you take a little extra time to talk to Mrs. Jones about her husband because you just didn't have the time yesterday. She really appreciates it, gives you a hug and just as you are about to turn the handle on the exit door to dash over to the office, a pesky nurse says (sorry Becky), "don't forget to see Mrs. Peters, she was admitted to you at 3 am this morning with ST's down, troponin I of 0.7. "No one called me " I say, trying to explain why Elvis is about to leave the building. " The nurse never misses a beat and says "She's OK now,....ST's back to baseline on a heparin drip, beta blocker and aspirin. Here's her chart", and pulls me into her room where her family has been anxiously awaiting my arrival.
"GREAT", I think to myself. I took extra time to try and do a good thing for one patient only to realize I've done a bad thing for another by not allowing myself enough time to take this patient to the cath lab. The ER called my partner who is already doing a case in the lab and either forgot to call me just hasn't had time. None the less, I check the cath lab and we are booked until late evening. My office doesn't wind down until after the first open time slot. The patient doesn't want to be NPO all day and quite frankly, no one looks forward to doing a cath late in the evening.
Now, with TIMACS, we have good news for our patients with ST''s down since there is no advantage or disadvantage of going to the cath lab late or early (EXCEPT in those with GRACE scores > 140) and good news for our office patients that we can actually plan on being to the office on time, well at least sometimes. However, early invasive strategy had a large impact on reducing the rate of refractory ischemia by 70% which prompted the "take me early" direction given by Dr Bhat.
Though Dr. Bhat, the commentator said if he were the patient, he would want us to "take him early" to the lab, it's not always practical and in those circumstances patients can safely wait. I fear the only losers in the "waiting" strategy are the insurance companies who expect us to serve 24/7, even though a quick phone call to their office on the weekend will certainly verify that they do not.