Impact of a Maternal Early Warning System and Severe Hypertension Safety Bundle on Timely Treatment of Hypertensive Emergencies: A Quality Improvement and Health Equity Initiative.

BACKGROUND

Hypertensive disorders of pregnancy are a leading cause of pregnancy-related morbidity and mortality. Timely treatment of a hypertensive emergency has the potential to reduce preeclampsia-related morbidity and mortality.

OBJECTIVE

To evaluate the impact of quality improvement and patient safety initiatives on timely treatment of hypertensive emergencies in pregnancy and racial and ethnic disparities.

SETTING

Maternity teaching hospital in Texas Medical Center.

POPULATION: Pregnant and postpartum women with hypertensive emergencies.

METHODS

A retrospective chart review of all hospital deliveries with a hypertensive emergency was conducted from 1 January 2017 through 31 December 2024. During the study period, our hospital implemented a maternal early warning system (MEWS) and a patient safety bundle for severe hypertension (SHTN) in pregnancy. All deliveries ≥ 20 0/7 weeks were included.

MAIN OUTCOMES MEASURES: Rate of timely treatment of SHTN, overall and by race and ethnicity.

RESULTS

There was a statistically significant improvement in the rate of timely treatment of SHTN with implementation of MEWS (69.5% at baseline/phase 1 vs. 79.9% with MEWS/phase 2, p < 0.001, 15% improvement) and then again with implementation of the SHTN bundle/phase 3 (88.8% in phase 3, 11% improvement compared to phase 2 and 27.8% improvement compared to phase 1, p < 0.001). Changes over time within each racial and ethnic group indicated that the rate of timely treatment of a hypertensive emergency increased significantly for NH-Black, NH-White and Hispanic patients from phase 1 to phase 2 and for all groups from phase 1 to phase 3. The disparity in treatment fallouts and timely treatment was eliminated with MEWS modifications and the patient safety bundle in the final phase.

CONCLUSION

Quality improvement and patient safety efforts that standardise response to and treatment of hypertensive emergencies can lead to improvement in timely treatment and elimination of racial and ethnic disparities.