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

Abstract

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.