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

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Quality improvement report
Ensuring safe and equitable discharge: a quality improvement initiative for individuals with hypertensive disorders of pregnancy
  1. Kathleen M. Zacherl1,
  2. Emily Carper Sterrett2,
  3. Brenna L. Hughes3,
  4. Karley M Whelan1,
  5. James Tyler-Walker4,
  6. Samuel T Bauer3,
  7. Heather C Talley4,
  8. Laura J Havrilesky5
  1. 1 OB/Gyn, Duke University School of Medicine, Durham, North Carolina, USA
  2. 2 Pediatric Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
  3. 3 Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
  4. 4 Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
  5. 5 Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
  1. Correspondence to Dr Kathleen M. Zacherl, Obstetrics & Gynecology, University of Connecticut School of Medicine, Farmington, CT 06030, USA; zacherl{at}uchc.edu

Abstract

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.

  • Obstetrics and gynecology
  • Quality improvement
  • Statistical process control
  • Womens health
  • Patient-centred care

Data availability statement

Data are available upon reasonable request. Deidentified data analysis is available upon request for all figures, tables and supplementary material.

https://doi.org/10.1136/bmjqs-2024-017173

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    Data availability statement

    Data are available upon reasonable request. Deidentified data analysis is available upon request for all figures, tables and supplementary material.

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    Footnotes

    • Contributors KMZ was the guarentor, project lead and contributed to the design, analysis and interpretation of data. ECS was a principal advisor for the design, analysis and interpretation of data. BLH was the sponsor of the project involved in the design, analysis and interpretation of data. KMW was the lead medical student in the project involved with the design, analysis and interpretation of data. JT-W was the lead data analyst involved in the analysis and interpretation of data. STB was an advisor of the project involved in the design, analysis and interpretation of data. HCT was the nursing lead on the project involved in the design, analysis and interpretation of data. LJH was the senior author and advisor to the design, analysis and interpretation of data. ECS, BLH, JT-W, STB, HCT and LJH were involved in critical review of the work; final approval of the version to be published; and agreement to be accountable for the work. KMZ and KMW were involved in drafting the work; final approval of the version to be published; and agreement to be accountable for the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.