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Obstetric Quality and Safety

Poster Session 3

(844) Timeliness of diagnosis and treatment of postpartum hypertensive disorders in the Emergency Department

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: This study aims to assess the time to diagnosis and treatment of hypertensive disorders during the postpartum period in the Emergency Department, particularly focusing on potential disparities in care and identify areas for quality improvement.

Study Design: The study was conducted at a multi-centered large medical institution in the metro-Detroit area, analyzing postpartum ED visits from November 2015 to December 2022. The primary analysis focused on the time elapsed between severe range blood pressure readings and the administration of antihypertensives. Secondary analyses included the presence of essential laboratory work up such as complete blood count, complete metabolic panel, urine protein and creatinine.

Results:  Among the 430 women who presented to the ED during the postpartum period with hypertension, 72.6% had preeclampsia with severe features, and 13% had chronic hypertension with superimposed severe preeclampsia. Of the patients with severe hypertension, only 72% received a complete blood count, 66% underwent evaluation of creatinine and liver profile, and 4% had a urine protein ordered. The average time from severe range blood pressure to antihypertensive administration was 189 minutes for Black patients and 370 minutes for White patients. There were no statistically significant differences in the time of first blood pressure reading, laboratory evaluation, or treatment of severe range blood pressure between racial groups.

Conclusion:

This study identified the most significant area for improvement in the timely administration of antihypertensive medication following severe range blood pressure readings. Additional areas for improvement were observed in ordering essential laboratory tests to assess the severity of preeclampsia. Surprisingly, our institution demonstrated equal expeditious care for both white and black patients, contrary to existing literature indicating potential disparities. Based on these findings, a targeted quality improvement plan will be implemented to enhance the identified areas of concern.