Implementation of a novel surveillance and clinical decision support technology for the management of severe maternal hypertension.

OBJECTIVE

Hypertensive disorders contribute significantly to maternal morbidity and mortality. We sought to evaluate the impact of a clinical decision-support (CDS) system on maternal hypertension treatment. The CDS (GE HealthCare, Chicago, IL, USA) utilized digital CDS algorithms based on the American College of Obstetrics and Gynecology maternal hypertension treatment protocols.

STUDY

DESIGN

We conducted a retrospective analysis of patients delivering at Henrico Doctors Hospital (Richmond, VA) to compare diagnosis and treatment of severe maternal hypertension before (pre-CDS group, July 1, 2020 - November 2, 2020, n = 1337) and after (CDS group, November 3, 2020 - August 31, 2021, n = 3476) implementation of the CDS system.

RESULTS

Patients from the pre-CDS and CDS groups were of similar age, gestational age, race/ethnicity, body mass index, and obstetric history. A similar proportion of patients in the pre-CDS (19.6 %) and CDS groups (18.6 %) had pre-existing hypertension and approximately 10 % of all patients experienced a hypertensive episode during admission. The CDS group had a significantly (P < 0.001) higher rate of order set compliance (92.4 %) than the pre-CDS group (7.4 %). The CDS group had a significantly shorter time to first medication than the pre-CDS group (median, 14 vs 26 min, respectively) and a shorter hypertensive episode duration.

CONCLUSION

The introduction of a CDS system was associated with improved management of severe maternal hypertension. The associated reduction in hypertensive episode duration suggests that early and aggressive therapy, facilitated by the CDS system, positively changed the trajectory of clinical illness.