Education & Call Backs for Patients with Hypertensive Disorders of Pregnancy Increases Adherence to Postpartum Care

The Alliance for Innovation on Maternal Health Hypertension Safety Bundle recommends postpartum a blood pressure (BP) follow-up within 3-7 days of discharge for patients with Hypertensive Disorders of Pregnancy (HDP). Prior to this pilot, only 9% of patients at The George Washington University Hospital (GWUH) with HDP met this goal. In January 2023, GWUH initiated a call-back program to increase postpartum follow-up and improve education for HDP patients. GWUH’s OB team identified inpatients with HDP and placed an “HDP Order” in the EMR, which initiated hypertension education and a call-back. A RN called patients 3-5 days after discharge to review home blood pressures, screen for preeclampsia (PEC), ensure medication adherence, and discuss follow-up. GWUH enrolled 125 patients in the pilot. The RN reached 88 (71%) of patients; 23 patients required medical follow-up, came to triage, or had medications titrated remotely; 40 patients had normal BPs; 25 patients had no BP cuff or were not taking their BP; 37 patients were not reached; and for those patients GWUH successfully facilitated an outpatient follow-up for 17 patients. Of the patients enrolled, 63% were Black or African American, yet 92% who had no BP cuff were Black or African American, representing a racial disparity. The program improved the recommended 3–7-day follow-up eight-fold and standardized PEC education. Patients without a cuff were disproportionately Black or African American. GWUH will partner with pharmacies and insurance companies and seek funding to ensure that every at-risk patient leaves GWUH with a blood pressure cuff.

Authors: Sheetal Sheth, MD; Emily Nuss, MD; Erika Sasaki, MD; Phyllis Harris-White, RN; Lauren Wohl, DPT, CPHQ; Kathryn Marko, MD; and Lisa Cook, RN