Improving Compliance With Preeclampsia Guidelines Through an Electronic Medical Record Alert [29M

Abstract

INTRODUCTION: Hypertensive disorders occur in 12-22% of all pregnancies, and account for 17% of maternal mortality in the US. In 2012 and 2013, the American College of Obstetricians and Gynecologists and the California Maternal Quality Care Collaborative released comprehensive guidelines for the diagnosis and treatment of preeclampsia. Electronic health records likely offer an opportunity to improve compliance with these guidelines via automated alerts. METHODS: A retrospective review of 289 patients admitted to the University of Minnesota Medical Center in 2015 with preeclampsia or similar disorder was completed. Compliance with the national guidelines for administration of rapid-acting antihypertensives, IV magnesium for seizure prophylaxis, oral antihypertensives, and appropriate timing of outpatient follow up was evaluated. A similar review will be performed six months after the implementation of an automated alert in the electronic health record notifying providers of severe-range blood pressures. RESULTS: Data collection for phase 1 is currently in process, and data collection for phase 2 will begin in January 2017. It is expected that 85% of patients with sustained severe-range blood pressures admitted to the antepartum and labor and delivery units will receive rapid-acting antihypertensives within 60 minutes, but only 65% of those patients located on the postpartum unit will receive appropriately timed antihypertensive therapy. Compliance with appropriately timed antihypertensives will improve in all locations following implementation of the automated alert. CONCLUSION: The electronic health record has the potential to improve patient care and compliance with American College of Obstetricians and Gynecologists and CMQCC preeclampsia guidelines. More work is needed to optimize the electronic health record's benefit.