Key result
Implementation of a semiautonomous treatment algorithm for severe hypertension in pregnancy increased the administration of antihypertensive therapy within 15 minutes from 36.5% to 55.6% (P=.001).
Why the study?
To evaluate whether implementing a semiautonomous treatment algorithm was associated with improved compliance with guidelines for rapid administration of antihypertensive therapy in sustained severe hypertension.
Does a semiautonomous treatment algorithm improve the rapid administration of antihypertensive therapy in pregnant and postpartum patients with severe hypertension?
Cohort (n=959)
No
Does a semiautonomous treatment algorithm improve the rapid administration of antihypertensive therapy in pregnant and postpartum patients with severe hypertension?
Absolute Event Rate: 55.6% vs 36.5%
p-value: p=.001
Implementation of a semiautonomous treatment algorithm significantly improved the timely administration of antihypertensive therapy for severe hypertension in pregnant and postpartum patients.
May support semiautonomous algorithms for faster treatment; leaves open need for randomized confirmation on outcomes.
OBJECTIVE: To evaluate whether implementation of a semiautonomous treatment algorithm was associated with improved compliance with American College of Obstetricians and Gynecologists guidelines for rapid administration of antihypertensive therapy in the setting of sustained severe hypertension. METHODS: This was a single-center retrospective cohort study of admitted pregnant and postpartum patients treated for severe hypertension between January 2017 and March 2020. The semiautonomous treatment algorithm, which included vital sign monitoring, blood pressure thresholds for diagnosis of severe hypertension, and automated order sets for recommended first-line antihypertensive therapy were implemented between May 2018 and March 2019. The primary outcomes were the administration of antihypertensive therapy within 15, 30 and 60 minutes of diagnosis of severe hypertension. Comparisons were made between the preimplementation, during implementation, and postimplementation groups using χ2. Analysis was limited to the first episode of severe hypertension treated. Statistical significance was defined as P<.05. RESULTS: In total, there were 959 obstetric patients treated for severe hypertension, with 373 (38.9%) treated preimplementation, 334 (34.8%) during implementation, and 252 (26.2%) after implementation. Treatment of severe hypertension within 15 minutes was 36.5% preimplementation, 45.8% during implementation, and 55.6% postimplementation (P=.001). Treatment within 30 minutes was 65.9% in the preimplementation group, 77.8% during implementation, and 79.0% in the postimplementation group (P=.004). There was no difference in percentage of patients treated within 60 minutes (86.3% before, 87.7% during and 92.9% after implementation, P=.12). CONCLUSION: Implementation of a semiautonomous treatment algorithm for severe hypertension was associated with a higher percentage of pregnant and postpartum patients receiving the first dose of antihypertensive therapy within 15 and 30 minutes. Implementation of similar algorithms for this and other obstetric indications may decrease time to appropriate therapy and help improve care equity.
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Martin et al. (2021) conducted a cohort in Severe hypertension in pregnancy (n=959). Semiautonomous treatment algorithm vs. Preimplementation standard care was evaluated on Administration of antihypertensive therapy within 15 minutes of diagnosis of severe hypertension (p=.001). Implementation of a semiautonomous treatment algorithm for severe hypertension in pregnancy increased the administration of antihypertensive therapy within 15 minutes from 36.5% to 55.6% (P=.001).
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