Standardizing and Improving Blood Pressure Processes in General Academic Pediatrics
Poster #: 004
Session/Time: A
Author:
Elizabeth Garnett Harvie, BA
Mentor:
John Harrington, MD
Research Type: Quality Improvement
Abstract
INTRODUCTION:
Elevated blood pressure (BP) in pediatric patients is a major risk factor for future serious health complications. Despite its established importance, elevated BP and a subsequent hypertension diagnosis are often missed or poorly documented, particularly in pediatric populations. Within the General Academic Pediatrics (GAP) practice, inconsistent BP reporting has led to suboptimal patient care, highlighting an opportunity for quality improvement (QI).
METHODS:
A QI framework was used to process map current BP acquisition and reporting, identify areas of improvement, and implement a standardized process.
RESULTS:
Initial observations highlighted several areas for improvement within GAP. Primarily, the current electronic medical record (EMR) fails to account for a patient's height when flagging abnormal BP readings. There was also significant variation in procedures for both obtaining and documenting BPs in the practice. Interventions included (1) the creation and distribution of user-friendly nomograms that providers and nurses could use to clarify abnormal BP readings, (2) in-services with nursing staff, residents, and attendings to review and create an optimal process map, and (3) collaborations with information services (IS) to streamline documentation procedures within the EMR. There were notable increases in the number of correctly repeated and documented BP readings, longitudinal tracking using the patient problem and diagnosis lists, and inclusion of elevated BPs in patient notes, with preliminary results indicating an increase in overall process accuracy from 30% to 41%.
CONCLUSION:
Standardizing BP measurements and documenting them in the problem list when elevated proved challenging in the context of a busy academic pediatric practice. Using QI tools and education, we have created a process that we can now track and continue to improve upon. The 11% improvement in accuracy precipitates earlier identification of hypertension in pediatrics and is just the first step in this longitudinal QI project.
Elevated blood pressure (BP) in pediatric patients is a major risk factor for future serious health complications. Despite its established importance, elevated BP and a subsequent hypertension diagnosis are often missed or poorly documented, particularly in pediatric populations. Within the General Academic Pediatrics (GAP) practice, inconsistent BP reporting has led to suboptimal patient care, highlighting an opportunity for quality improvement (QI).
METHODS:
A QI framework was used to process map current BP acquisition and reporting, identify areas of improvement, and implement a standardized process.
RESULTS:
Initial observations highlighted several areas for improvement within GAP. Primarily, the current electronic medical record (EMR) fails to account for a patient's height when flagging abnormal BP readings. There was also significant variation in procedures for both obtaining and documenting BPs in the practice. Interventions included (1) the creation and distribution of user-friendly nomograms that providers and nurses could use to clarify abnormal BP readings, (2) in-services with nursing staff, residents, and attendings to review and create an optimal process map, and (3) collaborations with information services (IS) to streamline documentation procedures within the EMR. There were notable increases in the number of correctly repeated and documented BP readings, longitudinal tracking using the patient problem and diagnosis lists, and inclusion of elevated BPs in patient notes, with preliminary results indicating an increase in overall process accuracy from 30% to 41%.
CONCLUSION:
Standardizing BP measurements and documenting them in the problem list when elevated proved challenging in the context of a busy academic pediatric practice. Using QI tools and education, we have created a process that we can now track and continue to improve upon. The 11% improvement in accuracy precipitates earlier identification of hypertension in pediatrics and is just the first step in this longitudinal QI project.