Preventing Postpartum Readmissions for Hypertension

Background: Preventable readmissions related to hypertension were flagged as an area for improvement in OBGYN at Aurora Health Care. Hospital readmission rate is a Centers for Medicare and Medicaid Services focus, and in 2009, 27% of obstetric readmissions nationally were attributable to hypertensive disease. Our readmission numbers were higher, providing a system opportunity to improve healthcare quality and education and thereby reduce readmissions.

Methods: In a retrospective chart review from November 2014–2015, we identified 27 readmissions for postpartum hypertension, representing 57% of all obstetric readmissions. Discharge instructions and a decreased interval to blood pressure reassessment were identified as areas of improvement. Provider and nursing education focused on awareness of hypertension readmissions, increased surveillance of postpartum vitals for patients with risk factors, and discharge instructions with appropriate verbal and written precautions for signs and symptoms of disease. Blood pressure checks were scheduled for 72 hours after discharge.

Results: Written discharge instructions regarding postpartum hypertension significantly improved. However, improvement in discharge instructions did not decrease overall readmissions for postpartum hypertension. The average days to readmission increased from 6 to 8 days.

Conclusion: Improved patient care and patient education can occur with small changes. Engaging nursing assistance and providing education for comprehensive discharge planning helped with consistency. Large projects driven by administrative priorities are best addressed with a multidisciplinary approach.