title: Two Models to Conduct Nonphysician-led Exercise Stress Testing in Low to Intermediate Risk Patients.
abstract: Exercise stress testing (EST) is a noninvasive procedure that aids the diagnosis and prognosis of a range of cardiac pathologies. Reduced access is recognized as a limiting factor in enabling early access to treatment or safe and appropriate discharge. Increased accessibility can be achieved by utilizing nonphysician health practitioners to supervise tests. To implement nonphysician-led EST in clinical environments, there is a need for the development and administration of feasible and effective models.
  
  
  
  Via inpatient and outpatient referral, this article aims to present 2 standardized models of care for patients requiring EST for diagnostic and prognostic evaluation of numerous pathologies.
  
  
  
  An inpatient and outpatient model was implemented at the Royal Brisbane and Women's Hospital and Logan Hospital in Queensland, Australia between July 2013 and December 2015. Tests were performed by 2 cardiac scientists employed by each hospital. All tests were immediately reported by a cardiology advanced trainee registrar or consultant cardiologist.
  
  
  
  A total of 2095 tests were performed via the 2 models. Overall, 73 had a positive result (3.5%), 120 equivocal (5.7%), 129 inconclusive/submaximal (6.2%), and 1773 negative (85.2%). After further testing, 38 of the patients with positive and equivocal results were diagnosed with flow-limiting coronary artery disease. The remaining patients were resolved as negative through further diagnostic testing or lost to follow up.
  
  
  
  After implementation of the 2 models, patient flow was improved for earlier discharge, reduced waiting times, or timely identification of possible cardiac pathologies, thereby optimizing patient care.
authors.affiliation: From the *Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia; and †Department of Cardiac Investigations, Logan Hospital, Logan, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Scott
authors.forename: Mark
authors.initials: M
authors.lastname: Whitman
authors.forename: Alice
authors.initials: A
authors.lastname: McDonald
authors.forename: Meghan
authors.initials: M
authors.lastname: Webster
authors.forename: Carly
authors.initials: C
authors.lastname: Jenkins
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011237:Predictive Value of Tests; D011379:Prognosis; D011793:Queensland / Q000453:epidemiology; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors