title: Feasibility of referral of patients with elevated blood pressure from the Emergency Department.
abstract: Recent studies suggest that patients' elevated blood pressure (BP) readings in the Emergency Department (ED) may be due to hypertension (HTN) rather than pain and anxiety. Identifying BP patterns suggestive of HTN in the ED presents an opportunity for referral. The purpose of this prospective cohort study was to assess the feasibility of referral of ED patients with elevated BP readings suggestive of HTN. Adults with elevated BP suggestive of HTN and no history of HTN were tracked as to referral status using an actively monitored ED referral system. Patients referred to a community clinic network were tracked regarding clinic visits, subsequent BP, and diagnosis of HTN. Of 662 patients with elevated BP in the ED at triage, 197 (29.8%) had a pattern of blood pressure readings that were suggestive of HTN. Of these, 63 (32.0%) were referred to in-network clinics, 5 (2.5%) were referred out of network, and 129 (65.5%) were not referred. Of the 63 referred to network clinics, 17 (27.0%) kept their appointments and of those, 5 (29.4%) were diagnosed with HTN. Elevated BP was not mentioned in any ED physician referral notes as a reason for referral and the number of appointments kept among patients who were referred was low. Referral to outpatient clinics based on BP levels suggestive of HTN may not be feasible despite active referral systems.
authors.affiliation: Department of Clinical Research, Lutheran Medical Center, Brooklyn, NY 11220, USA. KJulliard@lmcmc.com
authors.forename: Kell
authors.initials: K
authors.lastname: Julliard
authors.forename: Craig
authors.initials: C
authors.lastname: Orvieto
authors.forename: Allison
authors.initials: A
authors.lastname: Win
authors.forename: Sam
authors.initials: S
authors.lastname: Sadler
authors.forename: Basel
authors.initials: B
authors.lastname: Al-Haddad
authors.forename: Bonnie
authors.initials: B
authors.lastname: Simmons
authors.forename: Laura
authors.initials: L
authors.lastname: Gabbe
authors.forename: Julie M
authors.initials: JM
authors.lastname: Pearson
authors.forename: Tom-Meka
authors.initials: TM
authors.lastname: Archinard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D058246:Prehypertension / Q000175:diagnosis* / Q000628:therapy; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D055815:Young Adult