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Emergency Department-Provided Home Blood Pressure Devices Can Help Detect Undiagnosed Hypertension.

ABSTRACT: INTRODUCTION:Emergency departments (EDs) are critical sites for hypertension (HTN) screening. Home blood pressure (BP) monitoring (HBPM) is used routinely in outpatient settings, yet its utility after the ED visit for those with elevated BP in the ED is unclear. AIM:In this pilot study, we assessed if HBPM could detect HTN in patients with elevated in-ED BP. METHODS:From September 2014 to July 2017, we recruited adult patients at an urban, academic ED with a triage BP???120/80 mmHg and no history of HTN into this prospective cohort observational study. After their ED visit, participants obtained BP measurements for two weeks using a validated HBPM. HTN was considered probable if the average HBPM BP was???135/85 mmHg. We calculated the proportion of participants whose ED BP measurement accurately predicted HTN using HBPM after discharge. RESULTS:Of 136 participants enrolled, 93 (68%) returned the HBPM with at least four home BP measurements [mean number of measurements obtained: 29 (SD: 17, range 4-59)]. Participants' median age was 40 years-old (IQR 34-48); 55% were female, 19% were black, and 58% were white. Forty-six percent of participants with elevated in-ED BP had HTN in follow-up. CONCLUSIONS:For patients with elevated BP in the ED, HBPM could be valuable for determining which patients have HTN and require expedient follow-up.

SUBMITTER: Goldberg EM

PROVIDER: S-EPMC6407636 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Emergency Department-Provided Home Blood Pressure Devices Can Help Detect Undiagnosed Hypertension.

Goldberg Elizabeth M EM Wilson Taneisha T Jambhekar Bianca B Marks Sarah J SJ Boyajian Michael M Merchant Roland C RC

High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension 20190119 1

<h4>Introduction</h4>Emergency departments (EDs) are critical sites for hypertension (HTN) screening. Home blood pressure (BP) monitoring (HBPM) is used routinely in outpatient settings, yet its utility after the ED visit for those with elevated BP in the ED is unclear.<h4>Aim</h4>In this pilot study, we assessed if HBPM could detect HTN in patients with elevated in-ED BP.<h4>Methods</h4>From September 2014 to July 2017, we recruited adult patients at an urban, academic ED with a triage BP ≥ 120 ...[more]

PMID: 30659517

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Project description:Emergency department (ED) crowding adversely affects multiple facets of high-quality care. The Commonwealth of Massachusetts mandates specific, hospital action plans to reduce ED boarding via a mechanism termed "Code Help." Because implementation appears inconsistent even when hospital conditions should have triggered its activation, we hypothesized that compliance with the Code Help policy would be associated with reduction in ED boarding time and total ED length of stay (LOS) for admitted patients, compared to patients seen when the Code Help policy was not followed.This was a retrospective analysis of data collected from electronic, patient-care, timestamp events and from a prospective Code Help registry for consecutive adult patients admitted from the ED at a single academic center during a 15-month period. For each patient, we determined whether the concurrent hospital status complied with the Code Help policy or violated it at the time of admission decision. We then compared ED boarding time and overall ED LOS for patients cared for during periods of Code Help policy compliance and during periods of Code Help policy violation, both with reference to patients cared for during normal operations.Of 89,587 adult patients who presented to the ED during the study period, 24,017 (26.8%) were admitted to an acute care or critical care bed. Boarding time ranged from zero to 67 hours 30 minutes (median 4 hours 31 minutes). Total ED LOS for admitted patients ranged from 11 minutes to 85 hours 25 minutes (median nine hours). Patients admitted during periods of Code Help policy violation experienced significantly longer boarding times (median 20 minutes longer) and total ED LOS (median 46 minutes longer), compared to patients admitted under normal operations. However, patients admitted during Code Help policy compliance did not experience a significant increase in either metric, compared to normal operations.In this single-center experience, implementation of the Massachusetts Code Help regulation was associated with reduced ED boarding time and ED LOS when the policy was consistently followed, but there were adverse effects on both metrics during violations of the policy.

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Emergency Department-Provided Home Blood Pressure Devices Can Help Detect Undiagnosed Hypertension.

Publications

Emergency Department-Provided Home Blood Pressure Devices Can Help Detect Undiagnosed Hypertension.

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