PHILADELPHIA — Two Penn Medicine doctors got here up with an unusual idea to cut back the variety of patients who develop dangerously hypertension within the weeks after giving birth: Stop asking them to come back into the doctor's office for blood pressure screening.
Dangerously hypertension is a number one explanation for maternal deaths and hospital admissions after childbirth and might often be prevented with regular check-ups. However, many latest parents are too overwhelmed to go to additional doctor's appointments themselves in the primary few days of their baby's life.
Doctors Sindhu Srinivas and Adi Hirshberg decided as a substitute to send patients home with blood pressure cuffs and directions on how you can text their readings twice a day for ten days.
Ten years later, the outcomes are so impressive that Penn has made it standard practice at its eight hospitals. The program, called Heart Safe Motherhood, has been nationally recognized, winning awards from the American Heart Association and the American Hospital Association, amongst others. And now it's getting used at other Philadelphia hospitals, including Thomas Jefferson University Hospital and Jefferson Einstein Philadelphia Hospital.
Since this system began in 2014, greater than 18,000 Penn patients have participated in it. It has helped to almost completely reduce the variety of patients readmitted for blood pressure complications inside every week of delivery and shut a racial disparity that had left many more black patients in danger for serious complications.
The reason: More and more patients are having their blood pressure checked after giving birth. Fewer of them need to return to hospital because doctors can recognize warning signs earlier and intervene.
“We're empowering patients,” said Hirshberg, chief of obstetrics on the Hospital of the University of Pennsylvania. “Without the monitors, this wouldn't be possible, but an important part of the program is educating people about why we're doing it.”
Shortly after giving birth to her son, Victoria Batista began experiencing splitting headaches, blurred vision, and stumbling as she walked round her Philadelphia home. She attributed all of it to exhaustion after a 67-hour labor that resulted in a C-section and the stress of caring for her first newborn.
“All these signs indicated that I had a problem, but I always ignored them,” said Batista, 32. “And then I got a notification: Check your blood pressure.”
She had a lot to try this she didn't wish to take care of it, but she knew her phone would just keep buzzing until she answered.
Batista punched within the numbers: 220/110, her blood pressure so high she was vulnerable to a stroke. Ten minutes later, someone from Penn called and told her she needed to go to the hospital immediately.
“Without this program and the harassment it brought, I almost died,” she said.
Combating inequality in maternal mortality
The program is a brand new solution to sobering statistics that show that Black Americans proceed to be greater than twice as prone to die while pregnant or childbirth or within the months following them, in accordance with the Centers for Disease Control and Prevention. The disparity endured despite a nationwide decline within the maternal mortality rate in 2022.
Distributing blood pressure cuffs alone won't solve the national maternal mortality crisis. But the Heart Safe Motherhood program has reduced readmissions for blood pressure complications amongst Penn's postpartum patients from 5% to 1%.
Philadelphia facilities say the Heart Safe Motherhood program has also helped them higher connect with their patients and potentially make progress in combating other deadly postpartum complications.
Jefferson launched this system in late 2021 and the Einstein campus in Philadelphia followed in spring 2022.
The response from patients and providers has been consistently positive, said Anneliese Gualtieri, patient safety and performance improvement coordinator for obstetrics and gynecology at Einstein.
“You’re actually collaborating with the patient in their care, and that’s something patients love to do – being part of their own solution,” she said.
Recognize symptoms early
Jasmine Hudson, a nurse at Penn's Diabetes Center, gave birth to her second child at Penn in May 2023. She credits the Heart Safe Motherhood program for saving her life just a few days later.
Hudson took home the blood pressure cuff offered by the nurses and diligently responded to the text prompts together with her blood pressure readings.
An automated algorithm analyzes the blood pressure readings provided by patients and alerts doctors to any abnormal results.
The program sends a text message back to let the patient know that their reading is nice or to ask them to repeat the test in just a few hours if the reading is elevated. If a patient doesn’t reply to the prompt, this system sends a reminder text message.
And if someone's reading is simply too high, patients receive a text message with the hospital's phone number and directions on who to ask.
Hudson didn't think much of it when a rather elevated reading got here back one morning. She felt drained and her husband said she seemed somewhat irritable – but she thought to herself: What young mother isn't?
“As mothers, we are used to providing for our families and others. We come second, third or fourth,” she said.
But after a second elevated reading, the automated program asked her to go to the hospital, where she stayed for 3 days.
Hudson was sent home with blood pressure medication, and over a yr later, he’s doing well.
Postpartum care at home
Hudson is one among about 18,000 Penn patients who’ve participated within the Heart Safe Motherhood program, which sees about 50 patients every day.
Staff concentrate on patients in danger for hypertension or preeclampsia, for instance, individuals with elevated test results while pregnant or immediately after birth or with a history of hypertension during a previous pregnancy.
Between 30 and 40 percent of Penn's delivery patients qualify for the procedure and are sent home with blood pressure cuffs and directions on how you can record their readings, says Srinivas, vice chair of quality and safety in obstetrics and gynecology at Penn. The cost of the device, about $30, is roofed by the health system for patients who don’t receive reimbursement from their insurance.
Before launching the Heart Safe Motherhood program, Penn asked at-risk women to come back back in the times after giving birth to have their blood pressure checked. Many never got here. For others, blood pressure was normal at their appointment, but after returning home, it began to rise again.
Black women were at higher risk than white women, with fewer follow-up blood pressure checks and more frequent readmissions to the hospital.
Far too often, Srinivas has witnessed a young mother go home healthy, only to return days later with life-threateningly hypertension.
“How could we not have known this would happen?” Srinivas wondered.
Now she doesn't need to worry as often. About 90% of patients within the Heart Safe Motherhood program attend the prenatal visits they request. This compliance rate is similar for black and white patients.
According to providers, this system addresses some key hurdles in managing postpartum blood pressure: parents don't have to acknowledge subtle, common symptoms on their very own, and so they don't have to go away their home.
“Access to care is one of the biggest issues,” said Ryan Brannon, gynecologist and director of obstetric quality and safety at Thomas Jefferson University Hospital. “Heart Safe Motherhood has allowed us to reach a larger population.”
Next steps to cut back maternal mortality
Despite the success of this system, much stays to be done.
“While home blood pressure monitoring is great, we need to have a system in place that can make a difference when blood pressure is elevated,” said Laura Hart, co-director of Temple's cardio-obstetrics program. “It's a multi-layered process.”
For example, if hypertension or preeclampsia occurs while pregnant, women are at higher risk for heart problems later in life.
While Temple Health has not adopted the Heart Safe Motherhood program, providers have spent hours talking with doulas, patients and other health leaders in the neighborhood concerning the symptoms of hypertension and who to contact, says Estefania Oliveros, who can be co-director of the cardio-obstetrics program.
At Jefferson's hospitals, Brannon and Gualtieri wish to expand the Heart Safe Motherhood program to incorporate other languages, comparable to Russian and Mandarin.
The program currently communicates with patients in either English or Spanish.
Penn doctors are testing what other maternal health complications, comparable to postpartum depression, they will alleviate through this system's monitoring approach.
And as a consequence of the success of Heart Safe Motherhood, the system now distributes blood pressure cuffs to at-risk women while pregnant to detect potential blood pressure complications even earlier.
Originally published:
image credit : www.mercurynews.com