Pulmonary Hypertension (PH) Hospitalization
Jaclyn Doyle, MS, APRN, FNP-BC, Nurse Practitioner (Adult Pulmonary Hypertension Program), Stanford Medicine
Hello. My name is Jaclyn Doyle and I am a Nurse Practitioner, also known as an Advanced Practice Provider at Stanford Hospital, with the Adult Pulmonary Hypertension service. Our pulmonary hypertension program at Stanford Medical Center was one of the first six PH Comprehensive Centers of Care to be accredited in the United States, showing recognition for our outstanding clinical care and access to cutting edge research opportunities. Should you find yourself needing hospital care, whether planned or unexpected, you can find comfort knowing that you’re in the competent hands of a nationally renowned medical team specializing in treating this disease process. Understanding how impactful a hospitalization can be mentally, emotionally and physically, I would like to provide you today with details regarding the pulmonary hypertension team that is responsible for patients’ medical care throughout a hospitalization, as well as discuss expectations for patients during an admission.
Meet your PH Team (Who Are My Medical Providers?)
Stanford Medical Center is an academic, teaching institution. This means that you will be treated by a wide variety of medical providers with the oversight of an Attending Physician. An Attending Physician is your Pulmonary Hypertension specialist who has completed all levels of medical training from residency to fellowship, which included specific training in the care of patients with Pulmonary Hypertension. Our team also consists of a Pulmonary Hypertension Fellow, who is a licensed physician completing one additional year of training specifically in the treatment of patients with PH. Stanford also employs Advanced Practice Providers, like myself, who are also known as APPs, that are licensed, board-certified Nurse Practitioners or Physician Assistants. The APP is typically responsible for the admitting and discharging of patients, in addition to providing daily medical care, so you will become quite familiar with us if you don’t know us already. The Attending Physician, PH fellow, and APP make up the core group of PH medical providers; however, it is important to point out that we often have a resident or fellow from a separate training program rotate on our service to familiarize him/herself with pulmonary hypertension to augment their training. But again, it is the core group of PH providers at Stanford that will ultimately make the medical decisions regarding your care.
Expectations of a Hospitalization (What Should I Expect During My Hospitalization?)
Pulmonary hypertension is a serious medical condition that may require an admission to the hospital at some point throughout the course of the disease. There are many reasons why a patient may need to be hospitalized. Some indications include: signs and symptoms of worsening PH or heart failure, such as fluid retention that requires IV diuretics (like Lasix); a newly diagnosed patient requiring expedited work-up including a right heart catheterization; or, the need to start an advanced therapy for pulmonary hypertension that should be done in a closely monitored setting. Patients can either be admitted through the emergency department or directly into a hospital bed, if the admission was pre-planned and not deemed emergent. If the admission is pre-planned, otherwise known as a ‘direct admission’, please be prepared to bring all of your current medications, especially PH-specific medications and all devices required to administer the medication. If you have sleep apnea and use a CPAP machine, it is often quite helpful to have patients bring their own device from home as well. Lastly, it is always a good idea to bring a copy of your advanced directive to have on file. If you do not have an advanced directive, one can be provided to you upon admission.
Once a patient is admitted into the hospital, you should expect various tests to take place, depending on the reason for admission. Typical tests include routine blood draws and imaging studies, such as an echocardiogram, or ultrasound of the heart, and x-rays when necessary. The placement of an IV should also be expected, as medications often require intravenous administration.
In addition to testing, we also utilize the time spent with us to provide patient education on the diagnosis of PH, the disease process, its management, and treatment, as well as introduce patients to our research team for possible enrollment in clinical research trials or studies. We utilize Clinical Nurse Specialists and Dieticians to provide heart failure education, which includes specific dietary recommendations and tips for day-to-day management of pulmonary hypertension, all with the goal of improving quality of life and preventing future hospitalizations. If a patient is starting on an advanced pulmonary hypertension medication that is delivered either through inhalation or continuous IV infusion (such as IV Flolan), then education is provided by a nurse from the specialty pharmacy that will be supplying that medication. We certainly acknowledge the need for emotional support during any hospitalization, and therefore, provide the services of our PH-designated social worker and case manager, who is available to meet with you and your family as needed. Average length of stay in the hospital can vary, but a 7-10 day admission it is not uncommon when starting new PH therapies. Lastly, patients can expect daily morning rounds with the core medical team, which may include residents or fellows from other specialties in medical training.
Finally, prior to discharge, you will have a clear understanding of your new treatment regimen and management of pulmonary hypertension, as well as the specifics around your follow-up with a PH specialist in our clinic. You will also be introduced to the PH Nurse Coordinator and provided the PH teams contact information to ensure a seamless transition of care from the inpatient to outpatient setting.
In conclusion, I hope that I’ve provided you with realistic expectations of a hospitalization as well as a brief introduction to our PH program and medical providers. Unfortunately, not all hospital admissions can be pre-planned, so please rest assure that should you find yourself requiring emergent hospitalization, someone from our team is available to care for you 24 hours a day, 7 days a week. After all, our patients are our priority! And welcome to Stanford!
Jaclyn Doyle, MS, APRN, FNP-BC
Adult Pulmonary Hypertension Service