Impact of EMR discharge notifications on rates of patient follow-up and treatment of hypertension: a retrospective cohort [abstract]
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Background: The dangers of untreated hypertension (HTN) are well known. Because of this, recognition of abnormal elevated blood pressure (EBP) during ED encounters is very important. We implemented an EMR alert which generates a notification to providers at the time of discharge if a patient’s blood pressure has exceeded 140/90 during their visit. The alert also prompts the clinician to provide the patient with a diagnosis of EBP or HTN, a primary care referral, and/or HTN specific discharge instructions. Objectives: We sought to determine if the alert led to improved patient notification of EBP and ultimately to improved primary care referral and follow-up. Methods: We conducted a retrospective chart review of 1001 charts (501 pre- and 500 post-intervention) at a tertiary care teaching hospital with annual census of 81,000. Data was abstracted from the electronic medical record by two trained researchers. Results: 40 (8.0%) patients in the pre-intervention group and 82 (16.4%) patients in the post-intervention group received either a new HTN diagnosis, a referral to primary care for blood pressure follow up, or discharge instructions regarding HTN (p<0.0001). A greater difference was seen among patients with no history of HTN (4.2% pre- and 18.3% post-intervention; p<0.0001). When limited to patients with at least two EBPs during the ED visit, the difference was more
pronounced (7.0% pre- and 27.4% post-intervention; p<0.0001). Following the ED visit, an equal number of pre- and post-intervention patients were seen in follow up within the next 3 months (54% vs 55%). Of those, only 29 patients (5.8%) in the pre-intervention group had a new antihypertensive or changes to their antihypertensive medications versus 54 patients (10.8%) in the post-intervention group (p<0.005). Conclusion: After the EMR alert was implemented, a greater proportion of patients received a key intervention (a new HTN diagnosis, a referral to primary care for follow up, or discharge instructions regarding HTN). This was most pronounced in groups with no prior history of HTN and patients with repeatedly elevated blood pressures during their ED visit. This intervention correlated with an increase in the number of patients who had adjustments to their antihypertensive regimens in follow up.