Improving Blood Pressure Screening in Neonatal Follow-up Clinic: A Quality Improvement Initiative

Abstract

Introduction: The American Academy of Pediatrics recommends blood pressure screening at every health care encounter in children younger than 3 years if they have a history of prematurity or other neonatal complications requiring intensive care because these children have an increased risk for hypertension. Methods: A multidisciplinary team conducted a quality improvement initiative to improve blood pressure screening at a single-center outpatient neonatal follow-up clinic. We developed a focused intervention program including a standardized blood pressure measurement protocol, staff training and education, and streamlined documentation. We conducted two Plan-Do-Study-Act cycles from November 2019 to January 2021. The outcome measure was the percentage of patients with a blood pressure measurement. Process measures included the percentage of medical assistants educated on the new protocol, percentage of patients 3 years, and younger old with the first blood pressure measurement taken from the right arm, and the percentage of patients 1 year and younger with 3 documented blood pressures. The balancing measure was staff satisfaction with time to obtain vital signs. We used statistical process control charts and Wilcoxon rank-sum test. Results: At baseline, only 15.3% of patients had documented blood pressure. During the 10-month intervention period, there were 954 patient visits. Overall, blood pressure measurement increased to 54.7% with study interventions. The balancing measure was not negatively impacted. Conclusions: After implementing a program of focused interventions, we substantially improved the frequency of blood pressure measurements and increased adherence to American Academy of Pediatrics screening guidelines. Improved blood pressure screening allows us to identify and evaluate at-risk infants after hospital discharge.

Improving Evidence-based Management of Children and Adolescents with Elevated Blood Pressure during a Well-Child Encounter: A Quality Initiative

“…Previous projects improved guideline adherence by 25%-75% with provider education, EHR enhancements, and aligning care with the AAP algorithms. 12,[26][27][28] Despite comparable baseline data and interventions, our QI achieved more modest results (27%), particularly in children under six. This population is often excluded in other works but is a focus of the current project, given the age distribution of the CHC population.…”

“…A novel approach of this initiative evaluated the primary outcome across age groups (preschool, school-age, adolescents). 12,[26][27][28] Despite constituting the smallest proportion of patients, adolescents were significantly more likely to receive a provider action than preschool and school-age children. It is unclear from the chart audit if clinicians missed elevated BPs in younger children or recognized them and intentionally did not act.…”