Highlighting Advanced Practice Providers at National Jewish Health
APPs at National Jewish Health include physician assistants, nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists and certified anesthesiologist assistants.
We recognize and celebrate providers who are certified and licensed to assess, diagnose, treat, and manage illnesses, prescribe medications, perform clinical procedures, and conduct clinical research in management of the whole individual. This important group of providers elevate the fields of medicine and nursing to ensure our patients and communities receive safe, high-quality, evidence-based care.
National Jewish Health recently expanded our Anesthesia CRNA Program through our Joint Operating Agreement with Saint Joseph Hospital. Our hospital will employ the CRNAs who provide anesthesia care for the Labor & Delivery Unit at Saint Joseph. National Jewish Health Lead CRNA Jeffery Zimmerman has been promoted to APP Manager for this expanded CRNA program.
Thank you to our leadership team for making this innovative model a reality!
Certified registered nurse anesthetists (CRNAs) practice in the Minimally Invasive Diagnostic Center (MIDC) providing high quality anesthesia care for patients undergoing procedures. Our CRNAs collaborate with proceduralists, nurses and techs to provide pre, intra and post anesthesia care for patients in the MIDC. We provide sedation and general anesthetics to assist the proceduralists (pulmonologists, gastroenterologists, and cardiologists) in gathering more objective data to assist in diagnostic criteria and assessing baseline/progressing disease processes for patients.
Our team of anesthetists are responsible for performing comprehensive assessments of patients' physical and anesthetic histories days prior to their procedure. As an outpatient center, we have clinical guidelines patients must meet to ensure optimal patient safety and outcomes. Notes written by our clinical colleagues and other tests such as echocardiograms are imperative to our pre-anesthetic assessment to certify that the patient is an appropriate fit for the MIDC.
A unique part of the CRNA job is meeting our patients for the first time in the preoperative interview. This is the brief opportunity we have to build a connection and reassure them that they are in some of the best hands in the country. We skillfully guide patients through their preoperative, intraoperative and postoperative care until we give our handoff to the recovery area nurses. It is such a delicate continuum of care and one that we proudly excel at here at National Jewish Health.
Our CRNA team recently made significant contributions to patient safety by creating and implementing a prescreening tool with criteria to identify patients at higher risk for anesthesia complications. This tool has improved patient safety by ensuring that patients are appropriate for anesthesia at an ambulatory center.
This team includes:
Jeffery Zimmerman, MS, APRN, CRNA, lead APP (pictured)
Annabelle Flanagan, CRNA
Gabrielle Heckman, CRNA
Stephanie May, CRNA
Janna Mendoza, MS, APRN, CRNA
Vinh Nguyen, MS, APRN, CRNA
Alison Seders, MS, APRN, CRNA
Jessica VanderKwaak, MS, APRN, CRNA
Cardiology - General
Megan Knecht, MS, APRN, ANP-BC (left); Lindsay Scholl, MS, APRN, FNP-BC (center); and Camille Triebel, MS, APRN, ANP-BC
The general cardiology APP team includes Megan Knecht, Lindsay Scholl and Camille Triebel. The APP team provides comprehensive cardiac care, focusing primarily on diseases of the vasculature and muscle/pump portion of heart. APPs and physicians work collaboratively to manage several diagnoses including coronary artery disease, heart valve disease, cardiomyopathies, heart failure with reduced and preserved ejection fraction, amyloidosis, sarcoidosis, hypertension, dyslipidemia, post capillary pulmonary hypertension, and cardio-renal disease.
The APP team generally sees follow up patients after the cardiology physicians complete the initial consultation, order and review diagnostic tests with patients and their families, manage patients during acute episodes and titrate medications. They typically see patients once or twice a year alternating with their cardiology physician every other visit for continuity of care.
Additionally, cardiology APPs manage patients in the stress testing lab overseeing exercise and pharmacologic stress tests. They also are a resource for exercise physiology and echocardiogram technicians, as well as the testing RNs.
Cardiology - Electrophysiology
Anne Waugaman, MSN, APRN, ANP-BC, practices with Dr. Sung at main campus in cardiac electrophysiology (EP), which manages approximately 400 patients with implanted cardiac devices. She sees electrophysiology patients in clinic to manage their arrhythmias, including medication management and testing such as EKGs, lab work, stress tests, and pulmonary function tests.
Anne is responsible for remote monitoring of pacemakers, implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT) devices, and implanted loop recorders. She has a significant amount of additional training and education in EP and devices as well as an additional board certification from the International Board of Heart Rhythm Examiners in device management.
Patients with pacemakers, ICDs and loop recorders transmit daily information and alerts that may require immediate intervention. For example, abnormal lead measurements can indicate a problem with the device, and new onset atrial fibrillation or flutter may require immediate initiation of anticoagulation therapy to decrease risk of stroke. Other urgent arrhythmias include significant bradycardia, pauses or AV block necessitating pacemaker. Alerts for indications of worsening heart failure require referral to the cardiologist or heart failure specialist for early intervention. Patients also "mark" symptoms that can be reviewed by phone or in clinic. Remote monitoring can decrease hospitalizations as well as morbidity and mortality.
Cardiology - Pulmonary Hypertension
Vera Pillitteri, DNP, APRN, FNP-BC, AACC, practices with the pulmonary hypertension team in the cardiology clinic at main campus, covers cardiac stress testing in the cardiology testing suite, and sees patients in a research capacity in the Clinical Research Unit. She serves in a unique role in the Cardiology Division, managing pulmonary hypertension (PH) patients. Her role includes providing education for patients and families about their PH diagnosis, treatment plans and goals. Management includes testing and follow up, monitoring for signs and symptoms of clinical changes, assessing responsiveness and side effects of the treatment, evaluating fluid volume status and providing counseling to address concerns.
Vera collaborated with the pulmonary hypertension team to write an educational guide for patients living with PH, which is published on the LearnLiveBreathePH.org website (Opens in a new window) (Opens in a new window) (Opens in a new window) (Opens in a new window) (Opens in a new window) (Opens in a new window) (Opens in a new window) (Opens in a new window) Additionally, Vera served as a co-investigator on several ongoing PH/cardiology related studies.
The PH team includes Dr. M. Patricia George, MD; Dr. Darlene Kim, MD; Dr. Andrew Freeman, MD; Dr. Tim Lahm, MD; Dr. Adriel Malave, MD; Dr. Vera Pillitteri, DNP, Ann Randall, RN; Jordin Rice, RN; Rachel Callender, RN.
Lizzie Fan, PA-C (left) and Cori Fratelli, FNP-C, RN
The National Jewish Health Exercise and Performance Breathing Center empowers children and adults of any athletic or activity level to exercise to their fullest capacity and overcome associated medical and psychosocial barriers now and in the future through visionary, curious, collaborative, and elite clinical care, discovery, and education.
The vision of this program is to become the clinical world leader in the management of exertional breathing problems across the age spectrum through growth of the Exercise Induced Laryngeal Obstruction (EILO) program, and expansion of clinical programs at the interface of exercise/activity and respiratory disease.
The EILO program is located on the main campus and includes a dynamic interdisciplinary team of physicians, APPs, speech therapists, behavioral health specialists and nurses who work collaboratively to evaluate and manage patients with EILO throughout a week-long program. The program includes diagnostic and therapeutic laryngoscopy to identify EILO and train patients how to manage this problem through a novel breathing technique.
National Jewish Health and the University of Denver partnered to host the 2023 International Exercise & Breathing Conference here in Denver. The two-day conference featured expert speakers and best practices from our EILO program.
Jenna Milliron, MS, APRN, FNP, is on the Metabolic Health team, which manages diseases of metabolic health including obesity, dyslipidemia, prediabetes and type 2 diabetes. Drawing labs at initial visit to quantify presence and degree of insulin resistance, allows the team to use this information to guide lifestyle optimization recommendations related to sleep, nutrition, activity and stress management along with pharmacologic therapy if indicated. Patients are typically seen every six to 12 weeks, depending on individual need. Jenna also provides consultation for National Jewish Health inpatients as they are commonly treated with high dose steroids and may experience hyperglycemia during their treatment course. This is the first APP-led clinic at National Jewish Health. The team is proud to have introduced obesity management as a new service line for patients, and to help them reverse metabolic disease.
Jennifer Faber-Gerling, MS, ACNS-BC, ANP-BC (left) and Maria Rahardja, DNP, APRN, ANP
The Division of Mycobacterial and Respiratory Infections is a collaborative team of providers including physicians, nurse practitioners, respiratory therapists, dieticians and nurses that services primarily out-of-state patients who have pulmonary and extra pulmonary (soft tissue) mycobacterial infections and underlying bronchiectasis.
Located on the second floor of the Goodman building, this program offers an Adult Day Unit program (ADU) for new, out-of-state patients, which is a 10-day ambulatory evaluation of their underlying bronchiectasis and determine what predisposes them to this lung disease
The nurse practitioners (NPs) review all the intakes for prospective patients to determine what will be needed during their evaluations. They reach out to referring providers when needed and collaborate with consultants that may be needed to service these patients upon arrival. The NPs also provide valuable education to help patients have ownership of their disease process and be able to advocate for their health needs.
The Division of Environmental and Occupational Health Sciences (DEOHS), Occupational Medicine Clinic manages patients with sarcoidosis and occupational/environmental lung diseases, including but not limited to hypersensitivity pneumonitis, deployment lung diseases (asthma, bronchiolitis, rhinosinusitis, vocal cord dysfunction), coal workers pneumoconiosis, silicosis, chronic beryllium disease, and asbestosis. We also evaluate patients for possible adverse reactions to joint replacement components through our Metals program.
The Occupational Medicine APP team includes(left to right above) Jordan Bull, MPAS, PA-C; Richard Kraus, MPAS, PA-C; and Kalie Vonfeldt, MS, PA-C. They practice in the Occupational Medicine clinic at main campus. Richard also practices at offsite screening clinics for miners (coal, uranium, metal, and non-metal) in Pueblo; Montrose; Craig; Casper, Wyoming; and Page, Arizona.
These APPs are knowledgeable about the various federal government benefits programs and manage occupational and environmental related lung diseases with an outstanding team of renowned physicians. They obtain in depth occupational and environmental histories to determine if there are any exposures which may be a contributing cause to their lung disease. If patients have an occupational or environmental lung disease, they assist patients with navigating workers compensation, insurance, and disability benefits. Additionally, these APPs collaborate with our research teams to perform groundbreaking research.
Bronwyn Long, DNP, MBA, ACHPN, AOCNS, ACNS-BC (left) and Katie Rosen, MSN, APRN, ANP-C
The Palliative Care team is comprised of nurse practitioners (NPs) and a licensed social worker who provide palliative and supportive care to patients with lung and other cancers, chronic obstructive pulmonary disease, interstitial lung disease, pulmonary hypertension, neuromuscular disorders, cystic fibrosis and autoimmune diseases.
The NPs in the Palliative/Supportive Care practice manage symptoms, assist with advance care planning, and offer psychosocial support. They provide an intake visit and follow up at one month to discuss the plan of care, or every three months if the plan includes controlled substances. These APPs manage some patients’ pain associated with a condition treated at National Jewish Health, but they do not provide a primary pain service. Patients who have chronic pain or a pain disorder should be referred to an outside pain clinic.
Bronwyn was awarded a $10,000 grant from American Nurses Foundation & Hospice and Palliative Nurses Association in 2012. She served as principal investigator conducting a pilot study, “Improving Quality of Life in Chronic Obstructive Pulmonary Disease by Integrating Palliative Approaches to Dyspnea, Anxiety, and Depression.” Study results were published in the December 2014 issue of the Journal of Hospice & Palliative Nursing.
Katie recently completed a master’s certificate and palliative care, and she is currently expanding her practice to provide palliative care for patients with chronic lung disease, or other diseases which cause respiratory failure, including pulmonary hypertension, and amyotrophic lateral sclerosis (ALS).
The Pediatric Day Program is in the Division of Pediatric Allergy & Immunology, and is located on the 2nd floor of the Smith building on main campus. This program provides multiday, intensive outpatient therapies for complex allergic and immunologic conditions such as asthma, eczema, environmental allergies, food allergies, food protein-induced enterocolitis syndrome (FPIES), immune deficiency, bronchiectasis and rare pulmonary diseases. Patients stayr 1-2 weeks at a time and receive ongoing education, therapies, diagnostics and care from 8 a.m. to 5 p.m. each day. This is the only program of its kind in the U.S. Families come from across the country for the intensive and expert care that we provide.
Elizabeth Gyorkos, PA-C, is the first provider that Day Program patients spend time with. She reviews records, tests and results that patients have brought with them, ask both patients and parents what their goals are in coming to the program and communicates the patient's picture to the Day Program care team. As the team leader, she ensures communication is timely and accurate, that tests results are communicated to the care team and that patients know their schedule and understand what they've learn each day.
Elizabeth developed an Asthma Tune Up (Adherence) Program using the Propeller Health device. This program has helped pediatric patients understand more about asthma, what each of their medications do to help control their disease and become more adherent to their asthma medication plans, which improves control overall.
Patricia (Trish) Taylor, FNP-C, MPH