You are consulted as the HPN expert by the inpatient cardiology team to facilitate discharge for a 3 year-old female with a history of heart transplant for hypoplastic left heart syndrome was admitted for new onset 3-week history of vomiting, diarrhea and weight loss. Diagnostic laboratory and imaging studies are still pending. Patient started parenteral nutrition yesterday. Gastroenterology is planning on pursuing an further evaluation of change in feeding tolerance from baseline. Patient is stable from a cardiac perspective.
What is your next step?
A. Informally consult with family to introduce HPN program. Do not write note in chart in medical record, because conversation was informal and you do not want to leave impression that HPN team is assuming responsibility for care.
B. Collaborate with medical, gastroenterology and nutrition team to facilitate completion of diagnostic work-up of feeding intolerance prior to formal HPN consultation.
C. Initiate immediate HPN consult for prompt discharge. Insist that all further studies including GI work-up be done as outpatient in order to reduce patient's length of stay and quality of life.
D. Refuse HPN consult, because HPN not indicated for any patients with cardiorespiratory diseases whatsoever.
E. Request team meeting to review short-term and long-term goals of care and how HPN might help achieve these goals before agreeing to formal HPN consult per protocol.