| Description |
Background: Hypertension in pregnancy (PIH) is a complex medical condition that significantly increases the risk of maternal and fetal mortality and morbidity. Early recognition and intervention are essential to avoid poor outcomes. Without appropriate treatment, hypertensive patients are at heightened risk for cardiovascular events, organ failure, stroke, and death. Medical providers must be proficient in early detection, appropriate intervention, and evidence-based delivery planning to avoid these adverse events. Local Problem: A prominent academic hospital in the Salt Lake Valley, serving a diverse population that includes urban, rural, and high-risk pregnancies, lacked a standardized admission protocol for PIH patients. The obstetric-based emergency department followed a first-come, first-served admission system, which introduced variability in patient triage and opened opportunities for inconsistent care. The perceived barriers to effective care were primarily attributed to insufficient education and training for medical assistants (MAs) and hospital unit coordinators (HUACs), contributing to the inefficient management of high-risk patients. Methods: A Quality Improvement initiative aimed to develop and implement a pregnancy-induced hypertension triage and standardized workflow in the obstetric-based emergency department (OBED) unit and assess the feasibility, usability, and satisfaction of the workflow changes. Interventions: Key stakeholders were identified from a multidisciplinary staff team, including APRNs, RNs, MAs, and HUACs. The initial phase of the QI project began with a review of the unit's current practices, and an in-depth literature review was conducted. Recommendations from current governing bodies of obstetrics medicine guided the creation of the PIH admission protocol, flowsheet, and intake form. Role-specific education sessions were provided. A PDSA model guided rapid cycle changes throughout the initiative. Results: Of the 145 staff members, 42 (29%) completed the pre-intervention surveys. Nine hundred eighty total patients were admitted to the unit during the project, with 152 patients presenting with a chief complaint of hypertension (15.5%), and 55 (36%) were evaluated using the PIH intake form. Priority of patients was assigned 9% of the time (n=5 out of the 55 forms). However, PIH-specific questions were used 100% of the time (n=55). Fewer staff completed the post-intervention survey (n=15). Most staff reported being very satisfied with the protocol (n=10, 67%). Conclusion: The OBED multi-disciplinary unit demonstrated satisfaction with a hypertension-specific admission protocol and expressed interest in its continued use. The pre-intervention survey highlighted the need for further education and training, particularly for MAs. The lack of MA participation was present in the survey responses and in-patient surveys. The post-intervention survey showed a strong interest in future utilization, indicating long-term clinical use potential. In the future, long-term standardization of admission protocols could improve staff satisfaction with work responsibilities. |
