Undiagnosed hypertension in the ED setting--an unrecognized opportunity by emergency nurses.
BACKGROUND
Hypertension is often undiagnosed, untreated, undertreated, and poorly controlled. Many patients use the emergency department as their primary source of health care, and the emergency department represents an opportunity to identify undiagnosed hypertension. We sought to (1) identify the prevalence of elevated blood pressures in low-acuity patients and (2) describe the existing practice of reassessment, treatment, and referral of abnormal vital signs in these patients.


METHODS
We conducted a retrospective study of 88 ED patients at an academic medical center. All patients meeting Emergency Severity Index level 4 or 5 criteria (low acuity) were eligible. The following variables were recorded: triage level, medical history and medications, disposition, and all blood pressures. The investigators independently reviewed and reached consensus regarding the following outcome variables: the need for and actual treatment of elevated blood pressure, and the need for and referral for blood pressure recheck after discharge.


RESULTS
Thirty-seven patients (45%) had hypertension by definition on arrival. Systolic hypertension was more common. Ten of the patients (27%) with elevated blood pressures had documented rechecks prior to discharge in the emergency department, and only one patient was referred for follow-up. Twenty-seven out of 37 low-acuity patients (73%) who presented with elevated blood pressures had no documentation of the blood pressure being rechecked and no documentation of the patient being referred.


CONCLUSIONS
Our data suggest that important opportunities for education and follow-up of hypertension are being missed.
Tanabe
Paula
P
Institute for Health Services Research and Policy Studies & Emergency Medicine, Northwestern University, Chicago, Ill, USA. p-tanabe@northwestern.edu
Steinmann
Rebecca
R
Kippenhan
Matt
M
Stehman
Christine
C
Beach
Christopher
C
D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000458:organization & administration; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016529:Emergency Nursing / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006973:Hypertension / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D033162:Incidental Findings; D007223:Infant; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D010353:Patient Education as Topic / Q000458:organization & administration; D015995:Prevalence; D012017:Referral and Consultation / Q000458:organization & administration; D012189:Retrospective Studies