(913) Impact of nurse support on readmission rates among patients in a postpartum blood-pressure monitoring program

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Sarah Shim, BS, MD

University of Minnesota
Minneapolis, Minnesota, United States

Coauthor(s)

JL

Jeanne Larson Moore

University of Minnesota
Minneapolis, Minnesota, United States
SF

Sarah Fladhammer

University of Minnesota
Minneapolis, Minnesota, United States
KW

Karen Wutolia

University of Minnesota
Minneapolis, Minnesota, United States
Tiffany Corlin, MD (she/her/hers)

University of Minnesota
Minneapolis, Minnesota, United States
Martina S. Burn, MD

Fellow
University of Minnesota
Minneapolis,, Minnesota, United States
Sarah A. Wernimont, MD, PhD

Assistant Professor
University of Minnesota
Minneapolis, MN, United States
Bethany Sabol, MD

Assistant Professor
University of Minnesota
Minneapolis, Minnesota, United States

Objective: To assess the impact of nursing support on postpartum readmission rates for patients participating in our home observation of postpartum elevated blood pressure (HOPE-BP) monitoring program.

Study Design: HOPE-BP is a 6-week postpartum remote monitoring program for patients with hypertensive disorders of pregnancy (HDP) discharging after birth from our institution. It was implemented in 2023 and uses Epic Care Companion and a registered nurse (RN) driven protocol, with physician oversight, for antihypertensive medication initiation/titration. Blood pressures (BPs) are monitored by the RN team Monday-Friday from 8AM-5PM. Outside of these hours, patients are directed to call the on-call provider for severe hypertension or escalating symptoms; however, active surveillance or response to increasing BPs does not occur during this unsupported time. We hypothesized that readmission rates would be higher during times when RN support was unavailable.

Results: We evaluated postpartum readmissions for all patients participating in HOPE-BP from the start of the program in November 2023 through June 2024. Among those enrolled in HOPE-BP (N=280; 75% of eligible patients), 2.8% were readmitted (N=8). 7 of the 8 were admitted for a new diagnosis of preeclampsia with severe features based on blood pressure criteria (chronic hypertension N=3, gestational hypertension N=3, and preeclampsia without severe features N=1). We observed, that as hypothesized, 75% (N=6) of these readmissions occurred at times without RN coverage. Figure 1 demonstrates the impact of HOPE-BP on the reduction of postpartum readmissions during RN-supported hours.

Conclusion:
Our data uniquely demonstrates the impact RN support has on reducing postpartum readmissions. Supported BP surveillance and management is critical to the program’s success in the prompt recognition and treatment of worsening hypertension and
reducing preventable readmissions.