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Am J Perinatol 2021; 38(10): 983-992
DOI: 10.1055/s-0041-1728835
SMFM Fellowship Series Article

Improving the Timely Delivery of Antihypertensive Medication for Severe Perinatal Hypertension in Pregnancy and Postpartum

Patrick Schneider   *
1   Department of Obstetrics and Gynecology, Pritzker School of Medicine, Evanston Hospital, NorthShore University HealthSystem/University of Chicago, Evanston, Illinois
,
Patricia Ann Lee King
2   Feinberg School of Medicine, Center for HealthCare Studies, Northwestern University, Chicago, Illinois
,
Lauren Keenan-Devlin
3   Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois
,
Ann E.B. Borders
1   Department of Obstetrics and Gynecology, Pritzker School of Medicine, Evanston Hospital, NorthShore University HealthSystem/University of Chicago, Evanston, Illinois
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Abstract

Objective Sustained blood pressures ≥160/110 during pregnancy and the postpartum period require timely antihypertensive therapy. Hospital-level experiences outlining the efforts to improve timely delivery of care within 60 minutes have not been described. The objective of this analysis was to assess changes in care practices of an inpatient obstetrical health care team following the implementation of a quality improvement initiative for severe perinatal hypertension during pregnancy and the postpartum period.

Study Design In January 2016, NorthShore University HealthSystem Evanston Hospital launched a quality improvement initiative focusing on perinatal hypertension, as part of a larger, statewide quality initiative via the Illinois Perinatal Quality Collaborative. We performed a retrospective cohort study of all pregnant and postpartum patients with sustained severely elevated blood pressure (two severely elevated blood pressures ≤15 minutes apart) with baseline data from 2015 and data collected during the project from 2016 through 2017. Changes in clinical practice and outcomes were compared before and after the start of the project. Statistical process control charts were used to demonstrate process-behavior changes over time.

Results Comparing the baseline to the last quarter of 2017, there was a significant increase in the administration of medication within 60 minutes for severe perinatal hypertension (p <0.001). Implementation of a protocol for event-specific debriefing for each severe perinatal hypertension episode was associated with increased odds of the care team administering medication within 60 minutes of the diagnosis of severe perinatal hypertension (adjusted odds ratio 3.20, 95% confidence interval 1.73–5.91, p < 0.01).

Conclusion Implementation of a quality improvement initiative for perinatal hypertension associated with pregnancy and postpartum improved the delivery of appropriate and timely therapy for severely elevated blood pressures and demonstrated the impact of interdisciplinary communication in the process.

Key Points

  • Process of hospital-level implementation of a state quality improvement initiative.

  • Evidence of improvement in care delivery for severe perinatal hypertension (HTN).

  • Episode related debriefing by the clinical team improved perinatal HTN care.

Keywords

bundles - debriefs - hypertension - pregnancy - postpartum - quality improvement - toolkits

* Present address: The Ohio State University Wexner Medical Center, Department of Obstetrics and Gynecology, 395 W 12th Avenue, 5th Fl, Columbus, OH 43210.


Supplementary Material



Publication History

Received: 30 June 2020

Accepted: 02 March 2021

Article published online:
02 May 2021

© 2021. Thieme. All rights reserved.

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