Language
English
Publication Date
12-1-2025
Journal
BJOG: An International Journal of Obstetrics & Gynaecology
DOI
10.1111/1471-0528.18273
PMID
40677173
PMCID
PMC12592757
PubMedCentral® Posted Date
7-17-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Background: Hypertensive disorders of pregnancy are a leading cause of pregnancy-related morbidity and mortality. Timely treatment of a hypertensive emergency has the potential to reduce preeclampsia-related morbidity and mortality.
Objective: To evaluate the impact of quality improvement and patient safety initiatives on timely treatment of hypertensive emergencies in pregnancy and racial and ethnic disparities.
Setting: Maternity teaching hospital in Texas Medical Center.
Population: Pregnant and postpartum women with hypertensive emergencies.
Methods: A retrospective chart review of all hospital deliveries with a hypertensive emergency was conducted from 1 January 2017 through 31 December 2024. During the study period, our hospital implemented a maternal early warning system (MEWS) and a patient safety bundle for severe hypertension (SHTN) in pregnancy. All deliveries ≥ 20 0/7 weeks were included.
Main outcomes measures: Rate of timely treatment of SHTN, overall and by race and ethnicity.
Results: There was a statistically significant improvement in the rate of timely treatment of SHTN with implementation of MEWS (69.5% at baseline/phase 1 vs. 79.9% with MEWS/phase 2, p < 0.001, 15% improvement) and then again with implementation of the SHTN bundle/phase 3 (88.8% in phase 3, 11% improvement compared to phase 2 and 27.8% improvement compared to phase 1, p < 0.001). Changes over time within each racial and ethnic group indicated that the rate of timely treatment of a hypertensive emergency increased significantly for NH-Black, NH-White and Hispanic patients from phase 1 to phase 2 and for all groups from phase 1 to phase 3. The disparity in treatment fallouts and timely treatment was eliminated with MEWS modifications and the patient safety bundle in the final phase.
Conclusion: Quality improvement and patient safety efforts that standardise response to and treatment of hypertensive emergencies can lead to improvement in timely treatment and elimination of racial and ethnic disparities.
Keywords
Humans, Female, Pregnancy, Quality Improvement, Retrospective Studies, Health Equity, Adult, Hypertension, Pregnancy-Induced, Texas, Time-to-Treatment, Patient Care Bundles, Healthcare Disparities, Emergencies, Hypertensive Crisis, disparity, hypertensive emergency, maternal early warning system (MEWS), patient safety bundle, severe hypertension
Published Open-Access
yes
Recommended Citation
Sims, Towana D; Shubert, Lauren; Denning, Stacie; et al., "Impact of a Maternal Early Warning System and Severe Hypertension Safety Bundle on Timely Treatment of Hypertensive Emergencies: A Quality Improvement and Health Equity Initiative" (2025). Faculty and Staff Publications. 5437.
https://digitalcommons.library.tmc.edu/baylor_docs/5437