Exercise Testing

Good Morning EPs!

I work at a hospital in CT overseeing cardiac stress testing (both exercise and nuclear testing). Our informed consent process has just been changed so that only providers (both MDs and APPs) can obtain consent before starting the appropriate stress test. This has caused significant delays in testing. If you are in a stress lab, who is obtaining consent? Are you / we able to in our role as exercise physiologists to obtain informed consent for stress testing?

I’ve worked in stress testing for 9 years and I (the EP)or the nuclear technician has always been the one to consent the patient. I’ve worked at three different companies in two different states and I have never heard of only having MDs and APPs consent

Yes, we had either the RN, the CEP or the Nuc Tech obtain consent. Basically, whoever greeted the patient first. If it was an MD or APP we would have never got any stress tests done as it was difficult to always find an MD readily available in the reading room. I would go to your Director to find out why that change was made and then go from there.

The last outpatient office that I worked in had this same requirement. It was a pain and tests were often delayed, but it was required. Essentially we had to identify the providers that were the most willing and try to go to them first. If they were unavailable we would go to the PA's, and finally the less agreeable providers and explain that no one else was available. It's also really important that leadership/management informs the providers that this change is required and they need to assist. One of the ways we attempted to get ahead of the clock was consenting 2 or 3 nuclear patients at the same time. Didn't always work, but if we could manipulate patient arrival times we tried to. It's a pain and providers don't make it easy, but it's doable.

I manage the cardiac diagnostic unit at Duke University Hospital and here we have the CEPs or RNs consent the patients for stress testing, but then that individual essentially does a brief case presentation to a fellow that is assigned to the unit that day and they sign off before starting the test. I know at other outpatient sites their exercise physiologist and nuclear tech staff consent the patients and an assigned doc of the day in clinic signs all the consents at the end of the day.