Time to diagnosis and treatment of emergent postpartum hypertensive disorders

Objective

Approximately 12% of postpartum patients seek treatment in the emergency department (ED). Hypertensive disorders are commonly seen during this time. This study assessed time to diagnosis and treatment of hypertensive disorders in postpartum patients with the hope to improve care through quality improvement.

Study Design

This is a retrospective study in metro-Detroit analyzing patients with hypertension in the ED from postpartum day 2 through 28. Primary outcomes included average time elapsed between severe range blood pressure (BP) readings to administration of antihypertensives and magnesium sulfate. Secondary outcomes included the presence of diagnostic laboratory testing, for classifying hypertensive disorders.

Results

Our cohort included 430 postpartum patients. The average time elapsed between the first severe BP reading and antihypertensive administration was 189 minutes for Black patients and 370 minutes for White patients. 72% received a complete blood count, 66% received creatinine and liver profile labs, and 4% had urine protein ordered. 15 patients (4.03%) with severe range BP received correct magnesium sulfate dosing. No statistically significant differences in time elapsed between severe BP readings to administration of antihypertensives, lab workup or administration of magnesium sulfate between racial groups were found.

Conclusion

Areas for improvement include the timeliness of administration of antihypertensive medications after severe range BP readings and ordering essential laboratory tests to classify the disorder. Fortunately, our institution did not demonstrate disparities of care with Black patients, despite existing literature. Moving forward, a targeted quality improvement plan will be implemented to address identified areas of concern.