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Provider self-report and practice: reassessment and referral of emergency department patients with elevated blood pressure.

Publication ,  Journal Article
Baumann, BM; Cline, DM; Cienki, JJ; Egging, D; Lehrmann, JF; Tanabe, P
Published in: American journal of hypertension
June 2009

We attempted to identify patient factors associated with blood pressure (BP) reassessment and to compare health-care provider self-reported reassessment and referral to actual practice in an emergency department (ED) setting.Provider reassessment and referral practices were determined through systematic review of 1,250 medical records at five EDs. Medical records were included if patients were > or =18 years, nonpregnant, presented with a systolic (SBP) > or =140 or diastolic BP (DBP) > or =90 mm Hg, and discharged. A separate questionnaire obtained self-reported practice patterns of health-care providers. Multivariate logistic regression identified factors associated with patient BP reassessment and referral.Of 1,250 patients, only 57% underwent BP reassessment and 9% received a referral for outpatient management. The most significant independent variables related to a reassessment were as follows: treatment of elevated BP in the ED (odds ratio (OR): 6.05; 95% confidence interval (CI): 1.80-20.31), chest pain (OR: 3.90; 95% CI: 2.37-6.42), and presence of an ED reassessment protocol (OR: 2.49; 95% CI: 1.77-3.50). The most significant factors associated with a referral included treatment of elevated BP in the ED (OR: 5.55; 95% CI: 2.72-11.32), presence of a reassessment protocol (OR: 2.58; 95% CI: 1.32-5.05), and a BP reassessment (OR: 2.56; 95% CI: 1.34-4.89). For self-reported practice patterns, 379 (72%) health-care providers completed questionnaires. Providers consistently overestimated their referral practices, yet the mean referral threshold values reported (SBP, 150 mm Hg; DBP, 93 mm Hg) were lower than the mean BP values of patients who actually received a directed referral (SBP, 170 mm Hg; DBP, 97 mm Hg, P < 0.0001).Reassessment and referral of discharged ED patients with elevated BP was infrequent and health-care providers overestimate their reassessment and referral efforts.

Duke Scholars

Published In

American journal of hypertension

DOI

EISSN

1941-7225

ISSN

0895-7061

Publication Date

June 2009

Volume

22

Issue

6

Start / End Page

604 / 610

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Retrospective Studies
  • Regression Analysis
  • Referral and Consultation
  • Outcome Assessment, Health Care
  • Middle Aged
  • Male
  • Incidence
  • Hypertension
 

Citation

APA
Chicago
ICMJE
MLA
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Baumann, B. M., Cline, D. M., Cienki, J. J., Egging, D., Lehrmann, J. F., & Tanabe, P. (2009). Provider self-report and practice: reassessment and referral of emergency department patients with elevated blood pressure. American Journal of Hypertension, 22(6), 604–610. https://doi.org/10.1038/ajh.2009.44
Baumann, Brigitte M., David M. Cline, John J. Cienki, Darcy Egging, Jill F. Lehrmann, and Paula Tanabe. “Provider self-report and practice: reassessment and referral of emergency department patients with elevated blood pressure.American Journal of Hypertension 22, no. 6 (June 2009): 604–10. https://doi.org/10.1038/ajh.2009.44.
Baumann BM, Cline DM, Cienki JJ, Egging D, Lehrmann JF, Tanabe P. Provider self-report and practice: reassessment and referral of emergency department patients with elevated blood pressure. American journal of hypertension. 2009 Jun;22(6):604–10.
Baumann, Brigitte M., et al. “Provider self-report and practice: reassessment and referral of emergency department patients with elevated blood pressure.American Journal of Hypertension, vol. 22, no. 6, June 2009, pp. 604–10. Epmc, doi:10.1038/ajh.2009.44.
Baumann BM, Cline DM, Cienki JJ, Egging D, Lehrmann JF, Tanabe P. Provider self-report and practice: reassessment and referral of emergency department patients with elevated blood pressure. American journal of hypertension. 2009 Jun;22(6):604–610.
Journal cover image

Published In

American journal of hypertension

DOI

EISSN

1941-7225

ISSN

0895-7061

Publication Date

June 2009

Volume

22

Issue

6

Start / End Page

604 / 610

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Retrospective Studies
  • Regression Analysis
  • Referral and Consultation
  • Outcome Assessment, Health Care
  • Middle Aged
  • Male
  • Incidence
  • Hypertension