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
