Abstract
Background: Emergency department clinicians often overlook asymptomatic hypertension (HTN). Clinical decision support can help improve adherence to the emergency nursing and emergency medicine clinical policy for asymptomatic HTN. While the policy indicates referral for all adults with two or more elevated blood pressures, less than 10% of patients are referred. We sought to determine the efficacy of an electronic health record clinical reminder on nursing (RN) reassessment of blood pressure (BP) for hypertensive patients. Methods: We conducted a 2-arm, pilot RCT, at an academic medical center in New York City. 107 RNs were randomized to the control group or to the intervention of a 'Best Practice Alert' (BPA) reminding him/her to recheck the BP in adult patients with an initial BP reading ≥140/90 mmHg. Descriptive statistics that included univariate and bivariate analyses were used to obtain adjusted measures of association between the intervention and control group. Results: RNs were more likely to repeat BP after receiving a BPA alert (56%) compared to RNs who did not receive an alert (44%) (OR=2.3, CI 2.1-2.5; p<.001). Patients who received BP reassessment were more likely to be triaged category 4 (OR 2.88, CI 1.81-4.59, p=.0001); age>75 years (OR 1.47; CI 1.07-2.03; p=.02); had Stage II HTN (OR 3.48; CI 2.63-4.59, p=.0001) and an ED length of stay of 3-4 hours (OR 5.85; CI 4.43-7.73; p=.0001). Conclusion: The BPA alert was effective in increasing BP reassessment by ED nurses. The findings of this study will help us translate this evidence ED practices.
Highlights
Hypertension is the most common cardiovascular disease (CVD) in the United States (U.S.), and as such, a frequently encountered condition among patients who visit the emergency department (ED).[1]
Results of our pilot randomized controlled trial (RCT) provide preliminary evidence that CDS, in the form of an electronic reminder, may improve nurse blood pressure (BP) reassessment among patients who present to the ED with an initial abnormal BP reading
While the majority of these studies reviewed were physician-driven, we believe our nurse focused CDS tool adheres to these features
Summary
Hypertension is the most common cardiovascular disease (CVD) in the United States (U.S.), and as such, a frequently encountered condition among patients who visit the emergency department (ED).[1] Professional emergency nursing (ENA) and emergency medicine (ACEP) organizations have endorsed efforts to better screen for HTN and help link those with uncontrolled BP to primary care.[1] They recommend referral for all adults in which their BP is persistently elevated (two or more BP readings ≥ 140/90 mm Hg). Clinical decision support can help improve adherence to the emergency nursing and emergency medicine clinical policy for asymptomatic HTN. While the policy indicates referral for all adults with two or more elevated blood pressures, less than 10% of patients are referred. We sought to determine the efficacy of an electronic health record clinical reminder on nursing (RN) reassessment of blood pressure (BP) for hypertensive patients
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