349: System improvements associated with reduced time-to-treatment for maternal hypertension in a statewide quality improvement Initiative

Abstract

The Illinois Perinatal Quality Collaborative (ILPQC)’s Maternal Hypertension (HTN) initiative increased the percentage of new onset severe HTN (BP ≥160/110) cases treated within 60 minutes from 41.5% to 85.0% at 110 hospitals through collaborative learning, rapid-response data, and quality improvement (QI) support. We aim to identify which hospital system improvements facilitated by the initiative were associated with reduced time to treatment (T2T) given the importance of T2T in severe maternal morbidity and mortality associated with severe maternal HTN. Participating hospitals reported T2T for all cases of severe maternal HTN during the QI initiative (April 2016-December 2017). Status of key system improvements were reported quarterly. A mixed effects generalized linear model was used to estimate the association between achievement of system improvements and T2T. Odds ratios were adjusted for hospital characteristics: birth volume, location (urban / rural), and patient mix (race and Medicaid status) in 2014. Hospitals that created standard protocols for early warning signs, diagnostic criteria, monitoring, and treatment had 1.43 the odds of treating a severe maternal HTN case in <60 minutes, compared with hospitals that did not (p=0.02). Unit education of providers and nurses (aOR: 1.37, p=0.01), rapid access to IV antihypertensive medications on antepartum/postpartum floors (aOR: 1.45, p=0.02), and multidisciplinary reviews (aOR: 1.40, p=0.02) were also associated with improved efficacy in reducing T2T of severe maternal HTN (Table 1). Implementation of four hospital system improvements (protocols for management of severe maternal HTN, unit education, rapid access to antihypertensive medications, and multidisciplinary case reviews) were significantly associated with reduced T2T of severe maternal HTN, regardless of hospital characteristics. Further investigation into the overall effect of other system improvements will clarify their role in reducing T2T. Identifying key hospital system improvements can inform future perinatal quality collaboratives and hospital-level QI initiatives to reduce T2T and improve outcomes for pregnant and postpartum women with severe HTN.