The authors assessed the process of blood pressure (BP) measurement and level of adherence to recommended procedures at representative sites throughout a large academic health sciences center. A casual observer assessed the setting and observed the process, noting the equipment, technique, and BP recorded by site personnel. A trained observer then repeated the patient's BP measurement following American Heart Association recommendations. Significant biases were observed between measurements by site personnel and the trained observer. Site personnel reported on average an increased systolic BP (SBP) of 5.66 mm Hg (95% confidence interval [CI], 3.09-8.23; P<.001) and a decreased diastolic BP (DBP) of )2.96 mm Hg (95% CI, )5.05 to )0.87; P=.005). Overall, 41% of patients had a !10-mm Hg difference in SBP between measurements. Similarly, 54% had differences of !5 mm Hg in DBP between measurements. Inaccurate BP measurement and poor technique may lead to misclassification, misdiagnosis, and inappropriate medical decisions. Concordance of measured SBP between our site personnel and trained observer was less than optimal. Several areas for improvement were identified. Routine calibration and use of system-wide standardized equipment, establishment of BP measurement protocols, and periodic technique and equipment recertification can be addressed in future quality initiatives. J Clin Hypertens (Greenwich). 2012;14:222-227. Ó2012 Wiley Periodicals, Inc.Blood pressure (BP) measurement is perhaps the most commonly performed procedure in the clinical encounter and one of the most important measurements in clinical medicine.1 Despite clear guidelines on appropriate techniques for BP measurement, 2,3 these recommendations rarely are followed by health care providers or personnel.1 There are numerous factors that influence accuracy of BP readings including those related to the patient, observer, instruments, and technique.2-4 Adequate rest time, diurnal variation, clinic atmosphere, pain, anxiety, smoking, and conversation all can have a significant impact on BP readings.4 Factors directly related to the observer include training, end-digit preference, and impaired hearing.2,3,5 Instrument accuracy, background noise, clothing interference, inappropriate cuff size and placement, posture, and inflation-deflation rate can influence BP measurements. Lack of repeated measurements further compounds the obtainment of an accurate reading.3 These multiple sources of potential error encountered in daily clinical practice emphasize the possibility for inaccurate results that can influence patient management. Accurate measurement of BP is essential in staging hypertension, ascertaining BP-related risk, and guiding management. Health care providers and personnel should be keenly aware of the need to carefully follow standardized procedures in order to achieve accurate and reproducible BPs. Despite education, clinic personnel who are aware of guidelines often do not follow them to the degree necessary to produce repeatable measures, and it h...

Background Currently, there is limited literature on the impact of the COVID-19 infection on medications and medical conditions in COVID-19 intensive care unit (ICU) survivors. Our study is, to our knowledge, the first multicenter study to describe the prevalence of new medical conditions and medication changes at hospital discharge in COVID-19 ICU survivors. Objective To determine the number of medical conditions and medications at hospital admission compared to at hospital discharge in COVID-19 ICU survivors. Methods Retrospective multicenter observational study (7 ICUs) evaluated new medical conditions and medication changes at hospital discharge in patients with COVID-19 infection admitted to an ICU between March 1, 2020, to March 1, 2021. Patient and hospital characteristics, baseline and hospital discharge medication and medical conditions, ICU and hospital length of stay, and Charlson comorbidity index were collected. Descriptive statistics were used to describe patient characteristics and number and type of medical conditions and medications. Paired t-test was used to compare number of medical conditions and medications from hospital discharge to admission. Results Of the 973 COVID-19 ICU survivors, 67.4% had at least one new medical condition and 88.2% had at least one medication change. Median number of medical conditions (increased from 3 to 4, P < .0001) and medications (increased from 5 to 8, P < .0001) increased from admission to discharge. Most common new medical conditions at discharge were pulmonary disorders, venous thromboembolism, psychiatric disorders, infection, and diabetes. Most common therapeutic categories associated with medication change were cardiology, gastroenterology, pain, hematology, and endocrinology. Conclusion and Relevance Our study found that the number of medical conditions and medications increased from hospital admission to discharge. Our results provide additional data to help guide providers on using targeted approaches to manage medications and diseases in COVID-19 ICU survivors after hospital discharge.

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