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Improving Obstetric Hypertensive Emergency Treatment in a Tertiary Care Women's Emergency Department.

Publication ,  Journal Article
Froehlich, RJ; Maggio, L; Has, P; Vrees, R; Hughes, BL
Published in: Obstet Gynecol
October 2018

OBJECTIVE: To assess treatment outcomes associated with an obstetric hypertensive emergency quality improvement intervention instituted in a tertiary care women's emergency department. METHODS: We conducted a cohort study of pregnant (20 weeks of gestation or greater) and postpartum (6 weeks of gestation or less) women treated for hypertensive emergency (systolic blood pressure [BP] 160 mm Hg or greater, diastolic 110 mm Hg or greater, or both) before and after a quality improvement intervention. A multidisciplinary task force revised clinical guidelines and nursing policy, updated electronic order sets, and provided staff education and clinical management aids. Data were collected by electronic chart review. The primary outcome was achieving goal BP (systolic 150 mm Hg or less and diastolic 100 mm Hg or less) within an hour of initial therapy. Secondary outcomes included time from first severe BP to 1) first antihypertensive treatment and 2) goal BP. RESULTS: There were no significant differences in baseline characteristics in the preintervention (n=173; September 2014 to September 2015) and postintervention (n=173; December 2015 to November 2016) groups, including gestational age, days postpartum, maternal age, race-ethnicity, or comorbidities. We found no significant difference in primary outcome frequency: 41% achieved goal BP within 60 minutes preintervention vs 47% postintervention (P=.28). Median time from first severe BP to first treatment was unchanged (30 minutes preintervention vs 29 minutes postintervention, P=.058); however, median time from first severe BP to goal BP decreased significantly (122 vs 95 minutes, P=.04). Confirmation of hypertensive emergency within 15 minutes (recommended) was only achieved in approximately 20% of women in either group. More women initially received intravenous antihypertensive treatment after the intervention (52% preintervention vs 80% postintervention, P<.001). CONCLUSION: A quality improvement initiative was not associated with more women achieving BP control within an hour of obstetric hypertensive emergency treatment, but was associated with decreased time to achieve control. This suggests improved clinical practice after the intervention.

Duke Scholars

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Published In

Obstet Gynecol

DOI

EISSN

1873-233X

Publication Date

October 2018

Volume

132

Issue

4

Start / End Page

850 / 858

Location

United States

Related Subject Headings

  • Young Adult
  • Tertiary Care Centers
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Obstetrics
  • Middle Aged
  • Hypertension, Pregnancy-Induced
  • Humans
  • Female
  • Emergency Service, Hospital
 

Citation

APA
Chicago
ICMJE
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Froehlich, R. J., Maggio, L., Has, P., Vrees, R., & Hughes, B. L. (2018). Improving Obstetric Hypertensive Emergency Treatment in a Tertiary Care Women's Emergency Department. Obstet Gynecol, 132(4), 850–858. https://doi.org/10.1097/AOG.0000000000002809
Froehlich, Rosemary J., Lindsay Maggio, Phinnara Has, Roxanne Vrees, and Brenna L. Hughes. “Improving Obstetric Hypertensive Emergency Treatment in a Tertiary Care Women's Emergency Department.Obstet Gynecol 132, no. 4 (October 2018): 850–58. https://doi.org/10.1097/AOG.0000000000002809.
Froehlich RJ, Maggio L, Has P, Vrees R, Hughes BL. Improving Obstetric Hypertensive Emergency Treatment in a Tertiary Care Women's Emergency Department. Obstet Gynecol. 2018 Oct;132(4):850–8.
Froehlich, Rosemary J., et al. “Improving Obstetric Hypertensive Emergency Treatment in a Tertiary Care Women's Emergency Department.Obstet Gynecol, vol. 132, no. 4, Oct. 2018, pp. 850–58. Pubmed, doi:10.1097/AOG.0000000000002809.
Froehlich RJ, Maggio L, Has P, Vrees R, Hughes BL. Improving Obstetric Hypertensive Emergency Treatment in a Tertiary Care Women's Emergency Department. Obstet Gynecol. 2018 Oct;132(4):850–858.

Published In

Obstet Gynecol

DOI

EISSN

1873-233X

Publication Date

October 2018

Volume

132

Issue

4

Start / End Page

850 / 858

Location

United States

Related Subject Headings

  • Young Adult
  • Tertiary Care Centers
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Obstetrics
  • Middle Aged
  • Hypertension, Pregnancy-Induced
  • Humans
  • Female
  • Emergency Service, Hospital