A standardized clinical assessment and management plan (SCAMP) reduces readmissions in postpartum hypertension

Abstract

Postpartum hypertension is one of the most frequent reasons for emergency department (ED) visits and readmission. We aimed to evaluate the effect of a SCAMP on these metrics in the postpartum period. We conducted a prospective cohort study of patients with postpartum hypertension at a tertiary care center for 3 months before and after enacting a SCAMP. The prospective group (P) were compared with historical controls (C). Elements of the SCAMP included 1) initiation or uptitration of medication for any blood pressure (BP) >150/100 or 2 BPs >140/90 within a 24hr period with goal of achieving normotension and 2) enrollment in outpatient virtual BP monitoring with close follow-up by the study team on discharge. Primary outcome was postpartum ED visit or readmission. Secondary outcomes were medication side effects, hypotension, utilization of the BP monitoring system, and length of stay (LOS). Chi-square, t-test, and Mann-Whitney U test were used as appropriate to compare groups. IRB#14-001098. 176 patients in (P) cohort were compared to 156 historical controls (C). The primary outcome of ED visits significantly decreased from 7.69% (C) to 1.13% (P) (p=0.003), and readmission rates decreased from 7.05% (C) to 1.70% (P) (p=0.02). When combined, the rate of patients who had either an ED visit or readmission decreased from 14.74% (C) to 3.21% (P) (p< 0.001). More patients were prescribed anti-hypertensives on discharge in (P) cohort (33.0% P vs 21.8% C, p=0.02), of whom 3 (5.2%) had hypotension (BP < 100/60) and 4 (6.9%) had side effects. The (P) cohort had longer mean postpartum LOS that was statistically significant (2.4 1.0 days P vs 2.1 1.0 days C, p=0.04). Total 100 (56.8%) patients were compliant with virtual BP monitoring, with 18 (18%) medication adjustments made per protocol. Utilizing a SCAMP encompassing strict BP control in the postpartum period followed by intensive outpatient follow-up can significantly reduce postpartum ED visits and readmissions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)