Implementation of Pre-Discharge Appointment Scheduling to Increase Attendance at Postpartum Hypertension Screening

Abstract

Problem & Purpose: A Mid-Atlantic community hospital experiences approximately 200 births a month; 50% of these births occur to mothers who self-identify as non-White (NW), and 20% of all patients have a hypertensive disorder of pregnancy (HDP). Blood pressure (BP) can rise without symptoms 3-10 days postpartum, and 75% of maternal deaths are related to HDP postpartum. Early detection of HDP reduces maternal morbidity and mortality. Currently only 40% of eligible hospital patients attend the recommended postpartum BP check appointment within 10 days, and 70% of the patients who do not attend this follow-up appointment self-identify as NW. This quality improvement project aims to increase attendance at the postpartum BP screening by scheduling the appointment prior to discharge. Methods: Patients with HDP are identified in the peripartum period by staff RNs, who share the names with the patient care assistants (PCAs), who use the hospital’s EMR secure message function to notify the maternity care practice scheduling personnel to schedule the appointment. Results: Appointments scheduled prior to discharge increased from 3% to 17.9%, appointments printed on the after-visit summary increased from 0 to 19.7%, and appointment attendance increased from 40% to 65%. When examined by patient identified race, appointment attendance for non-Hispanic White (NHW) patients decreased from 52% to 40.8% and increased from 48% to 59.2% for NW patients. Patients who did not attend the appointment and identified as NHW increased from 30% to 46.3%, while those identifying as NW decreased from 70% to 53.7%. Conclusions: Postpartum BP screening appointment attendance is increased, and racial disparities decreased, when appointment scheduling is initiated prior to discharge.