(438) Timely Treatment of Severe Hypertension: A Statewide Experience

To reduce the rate of severe morbidities in pregnant and postpartum patients with severe hypertension by 20% across the state of Tennessee.

Study Design:

Starting in spring 2021, 15 of the 59 birthing facilities in Tennessee (Level I – Level IV facilities) joined TIPQC to promote the consistent application of diagnostic and treatment bundles and protocols to optimize outcomes of patients with hypertensive disorders of pregnancy with AIM’s Severe Hypertension in Pregnancy Bundle. Participating hospitals were provided a toolkit, data collection tools, and a road map for implementation. Teams participated in monthly huddles, quarterly learning sessions, and annual meetings. While the global aim was to reduce the rate of severe morbidities in pregnant and postpartum women with severe hypertension, the participating hospitals focused on improving the percent of birthing patients with acute-onset hypertension who are appropriately treated within 1 hour.

Results:

There was successful treatment of >8550 birthing patients with acute-onset severe hypertension that persisted ≥15 minutes.   The five pilot teams, began in November 2020, and were able to increase their timely treatment of severe hypertension from 43% to 67% (Quarter 3 of 2020 to Quarter 4 of 2021), a 56% increase.  The additional 10 teams began the project in March 2021 and also improved their timely treatment – from 32% to 57% (a 78% increase). All the participating teams have monitored their timely treatment disaggregated by race and ethnicity to address any possible disparities, having noted great variability among hospitals.  These have been addressed utilizing PDSA cycles, particularly removing barriers including translation services.

Conclusion:

The collaborative and statewide efforts of TIPQC and the participating hospitals have all contributed to this improvement. While the project has already vastly increased the awareness and use of the hypertension protocols, the participating hospitals continue their efforts to further improve timely treatment.