EVENT: APHA 2023 

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Abstract

Background 

Birthing people experiencing severe pregnancy-related hypertension (SPH) face several challenges receiving care in the outpatient setting, where the timely escalation of care (i.e., medication and hospital transport) is crucial. While there is much emphasis on inpatient treatment of SPH, recognition and response in the outpatient setting can be lifesaving. The Alliance for Innovation on Maternal Health (AIM) proposes a patient safety bundle for recognition and response in the inpatient setting. Bundle implementation in the outpatient setting has the potential to further reduce hypertension-related morbidity through earlier identification and treatment. A process flow diagram (PFD) is a quality improvement tool that can identify actionable challenges and problems (“pain points”) by mapping the flow of care.

Methods

This study uses data from 11 key informant interviews with medical providers in outpatient clinics to develop PFDs by identifying care processes at each stage of the appointment. Care delivered is compared to the AIM bundle protocol, with deviations noted as potential pain points.

Results

Deviations from the protocol occurred when: 1) screening patient calls to identify a potential emergency; 2) scheduling timely appointments to assess warning signs; 3) administering medication when indicated, and 4) following an algorithm to determine when to escalate care. These pain points require attention when developing strategies for outpatient bundle implementation.

Conclusions

When implementing a patient safety bundle in an outpatient setting, mapping existing care processes is helpful to understanding deviations from recommended workflows. Our findings revealed pain points that warrant specific strategies for AIM bundle implementation in outpatient settings.