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PH Care Management Guidelines

Megan Farraj

Courtney Gray

Sharon Jones

Jeffrey Stewart

maureen seckel


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Conference: 2015 PH Professional Network Symposium

Release Date: 09.17.2015

Presentation Type: Abstracts

File Download: 2015 Symposium Abstract - 1012

File Size: (241 kb)

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To describe pulmonary arterial hypertension (PAH) patient management by the use of an inpatient and emergency department guideline available on the health system intranet portal.


Christiana Care Health System (CCHS) established a PAH Clinic in 2009 to meet the increasing community needs of this highly specialized population. In order to improve direct access of information to a wide array of providers and clinical staff, a PAH Clinical Management Guideline (CMG) was developed by a comprehensive system wide team. CCHS utilizes CMGs for interdisciplinary care of high risk diagnoses. The team felt it was crucial that our high risk, low volume PAH population would also strongly benefit from the accessibility and availability of a CMG. The PAH CMG is essential for staff to utilize at any point of patient contact in the CCHS system which includes: 2 hospitals with more than 1,100 patient beds, 3 emergency departments, a home healthcare service, preventive medicine, rehabilitation services, a network of primary care physicians and an extensive range of outpatient services. Fiscal year 2013 statistics include:

  • 1,496 medical and dental staff
  • More than 250 Medical-Dental residents and fellows
  • Nearly 3,000 nurses
  • 52,779 Admissions
  • 181,237 ED visits


The interdisciplinary team that was instrumental in developing the CMG included: the pulmonary hypertension physician, nurse practitioner, and case manager, emergency room providers and staff, performance improvement personnel, cardiology, pharmacy, staff nurses, respiratory therapy, clinical nurse specialist, and nurse educators. The format included pharmacotherapy, diagnostics, general measures, referral guidelines, key education issues, discharge criteria, and key outcomes.


Electronic access to the CMG provides timely, safe, and accurate “in the moment” information to all staff in any area of the healthcare system that may care for PAH patients. As research evolves and newer drug therapies are approved, the CMG is in a constant state of review and updates by the team. In addition, based on both patient and staff feedback, amendments geared towards safety have been added, such as specific procedures for priming lines, the care of patients during a magnetic resonance imaging (MRI) test, and patient location while in the hospital on certain PAH therapies.


Due to the high risk and low volume of PAH disease, a detailed, evidence-based management guideline is imperative in achieving safe administration of PAH medications. The guideline needs to be easy to access and readily available to all staff that may encounter a PAH patient.