Impact of maternal early warning system and safety bundle on timely treatment of severe hypertension

Abstract

To evaluate the impact of quality improvement (QI) and patient safety (PS) initiatives on timely treatment of severe hypertension (SHTN) in pregnancy. Retrospective chart review of all hospital deliveries between January 1, 2016 through June 30, 2022 with an episode of SHTN. During the study time period, our hospital implemented a maternal early warning system (MEWS), which mandated provider bedside evaluation for SHTN, and a patient safety bundle on SHTN in pregnancy that included team-based simulations around a new hospital guideline. Timely treatment of severe hypertension was defined as the percent of patients during their delivery hospitalization who received an antihypertensive agent within 60 minutes of the first documented severe blood pressure if it persisted for at least 15 minutes. Acceptable antihypertensive agents included intravenous labetalol or hydralazine or immediate release oral nifedipine. All deliveries ≥ 20 0/7 weeks were included. Data was analyzed using chi-square analysis. During the study period, there were 464 patients that met inclusion criteria prior to MEWS (phase 1), 1009 after MEWS (phase 2), and 375 with MEWS+bundle (phase 3). There was a statistically significant improvement in the rate of timely treatment of SHTN with implementation of MEWS (25.9% in phase 1 vs 44.0% in phase 2, p< .001) and then again with the bundle (61.3% in phase 3, p< .001 compared to phase 2). When looking at the data by race and ethnicity, non-Hispanic (NH) White patients were less likely to receive timely treatment as compared to NH-Black patients during phases 1 and 2, with elimination of this disparity in phase 3 (p < .001, p = .04, p = .42, respectively). Compared to NH-White patients, Hispanic patients were less likely to receive timely treatment during phase 2 only (p = .04). QI/PS efforts that standardize response to and treatment of SHTN can lead to improvement in timely treatment and elimination of disparities, which may in turn reduce severe maternal morbidity and mortality from hypertensive disorders of pregnancy.