Improving the Identification and Treatment of Postpartum Preeclampsia/Eclampsia and Obstetric Complaints in a Rural Emergency Department

Background: Obstetric patients that present to rural emergency departments (ED) have a higher rate of maternal morbidity and mortality than their urban counterparts. Rates are additionally increased if the patient is from a marginalized population. Mistreatment of obstetrical complaints often occurs in the postpartum period. Rapid identification of obstetric patients and up-to-date knowledge on treatment for obstetric complaints may help ED staff to reduce local rates of maternal morbidity and mortality. Local Problem: Not all obstetric patients triaged through the ED of Northeastern Nevada Regional Hospital (NNRH) are being identified or examined by a Qualified Medical Personnel prior to discharge. Blood pressure values that should trigger further investigation and treatment are also being missed. Methods: A quality improvement (QI) project was developed to increase staff knowledge of and confidence in identifying and treating obstetric complaints. A pre-survey identified areas of knowledge deficiency and an educational presentation was developed to address those deficiencies. Staff from the obstetric (OB) unit were also invited to take part to standardize the approach and treatment of obstetric complaints between units. Quick reference badge cards that summarized the educational presentation were distributed to both units and a post-education survey was collected six weeks after the intervention to evaluate if confidence in and knowledge of obstetric complaints and treatments increased. Results: Post-intervention, the study found that there was an overall increase in participants' confidence in and knowledge of identification and treatment of obstetric emergencies. However, poor participation in the educational presentation and the post-education survey decreases the validity of these results. Participant feedback did indicate that the quick reference badge cards were a useful tool in applying the knowledge learned to their practice. Conclusions: The educational presentation and the quick reference badge cards appear to be valuable resources in implementing practice change by reinforcing identification and American College of Obstetricians and Gynecologists (ACOG) recommended treatment of obstetric emergencies. Replication of this project with a higher number of participants is needed to determine if results are statistically significant.