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Ensuring safe and equitable discharge: a quality improvement initiative for individuals with hypertensive disorders of pregnancy.

Publication ,  Journal Article
Zacherl, KM; Sterrett, EC; Hughes, BL; Whelan, KM; Tyler-Walker, J; Bauer, ST; Talley, HC; Havrilesky, LJ
Published in: BMJ Qual Saf
May 17, 2024

OBJECTIVE: To improve timely and equitable access to postpartum blood pressure (BP) monitoring in individuals with hypertensive disorders of pregnancy (HDP). METHODS: A quality improvement initiative was implemented at a large academic medical centre in the USA for postpartum individuals with HDP. The primary aim was to increase completed BP checks within 7 days of hospital discharge from 40% to 70% in people with HDP in 6 months. Secondary aims included improving rates of scheduled visits, completed visits within 3 days for severe HDP and unattended visits. The balancing measure was readmission rate. Statistical process control charts were used, and data were stratified by race and ethnicity. Direct feedback from birthing individuals was obtained through phone interviews with a focus on black birthing people after a racial disparity was noted in unattended visits. RESULTS: Statistically significant improvements were noted across all measures. Completed and scheduled visits within 7 days of discharge improved from 40% to 76% and 61% to 90%, respectively. Completed visits within 3 days for individuals with severe HDP improved from 9% to 49%. The unattended visit rate was 26% at baseline with non-Hispanic black individuals 2.3 times more likely to experience an unattended visit than non-Hispanic white counterparts. The unattended visit rate decreased to 15% overall with an elimination of disparity. A need for BP devices at discharge and enhanced education for black individuals was identified through patient feedback. CONCLUSION: Timely follow-up of postpartum individuals with HDP is challenging and requires modification to our care delivery. A hospital-level quality improvement initiative using birthing individual and frontline feedback is illustrated to improve equitable, person-centred care.

Duke Scholars

Published In

BMJ Qual Saf

DOI

EISSN

2044-5423

Publication Date

May 17, 2024

Volume

33

Issue

6

Start / End Page

396 / 405

Location

England

Related Subject Headings

  • Quality Improvement
  • Pregnancy
  • Patient Discharge
  • Hypertension, Pregnancy-Induced
  • Humans
  • Health Services Accessibility
  • Female
  • Blood Pressure Determination
  • Adult
  • 4206 Public health
 

Citation

APA
Chicago
ICMJE
MLA
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Zacherl, K. M., Sterrett, E. C., Hughes, B. L., Whelan, K. M., Tyler-Walker, J., Bauer, S. T., … Havrilesky, L. J. (2024). Ensuring safe and equitable discharge: a quality improvement initiative for individuals with hypertensive disorders of pregnancy. BMJ Qual Saf, 33(6), 396–405. https://doi.org/10.1136/bmjqs-2024-017173
Zacherl, Kathleen M., Emily Carper Sterrett, Brenna L. Hughes, Karley M. Whelan, James Tyler-Walker, Samuel T. Bauer, Heather C. Talley, and Laura J. Havrilesky. “Ensuring safe and equitable discharge: a quality improvement initiative for individuals with hypertensive disorders of pregnancy.BMJ Qual Saf 33, no. 6 (May 17, 2024): 396–405. https://doi.org/10.1136/bmjqs-2024-017173.
Zacherl KM, Sterrett EC, Hughes BL, Whelan KM, Tyler-Walker J, Bauer ST, et al. Ensuring safe and equitable discharge: a quality improvement initiative for individuals with hypertensive disorders of pregnancy. BMJ Qual Saf. 2024 May 17;33(6):396–405.
Zacherl, Kathleen M., et al. “Ensuring safe and equitable discharge: a quality improvement initiative for individuals with hypertensive disorders of pregnancy.BMJ Qual Saf, vol. 33, no. 6, May 2024, pp. 396–405. Pubmed, doi:10.1136/bmjqs-2024-017173.
Zacherl KM, Sterrett EC, Hughes BL, Whelan KM, Tyler-Walker J, Bauer ST, Talley HC, Havrilesky LJ. Ensuring safe and equitable discharge: a quality improvement initiative for individuals with hypertensive disorders of pregnancy. BMJ Qual Saf. 2024 May 17;33(6):396–405.

Published In

BMJ Qual Saf

DOI

EISSN

2044-5423

Publication Date

May 17, 2024

Volume

33

Issue

6

Start / End Page

396 / 405

Location

England

Related Subject Headings

  • Quality Improvement
  • Pregnancy
  • Patient Discharge
  • Hypertension, Pregnancy-Induced
  • Humans
  • Health Services Accessibility
  • Female
  • Blood Pressure Determination
  • Adult
  • 4206 Public health