Nurse-led hypertension referral system in an emergency department for asymptomatic elevated blood pressure.
OBJECTIVE
To determine the characteristics of asymptomatic elevated blood pressure patients in an accident and emergency setting and assess the effect of a nurse-led intervention system.


METHODS
Cross-sectional study.


METHODS
Accident and Emergency Department of a regional hospital in Hong Kong.


METHODS
Patients with blood pressures of 140/90 mm Hg or above recorded twice (at triage and discharge) with no previous history of hypertension. Exclusion criteria were: (1) admission to hospital; (2) known hypertension; (3) referral for hypertension; (4) blood pressure higher than 180/120 mm Hg on rechecking.


METHODS
Patients were issued a referral by the discharge nurse to follow-up for blood pressure monitoring in primary care.


METHODS
Diagnosis of hypertension, follow-up rate, and risk factors of hypertension.


RESULTS
Of 245 patients with asymptomatic elevated blood pressure, we were able to contact 222 for follow-up, of whom 136 (61%) claimed to have been followed up for their blood pressure, and 48 (22%) were diagnosed to have hypertension. The nurse time for finding one case was 28 minutes. The projected impact could be large. If this simple nursing guideline is implemented territory-wide, more than 7000 new cases of asymptomatic hypertension might be picked up annually.


CONCLUSIONS
The implementation of a simple nurse-led hypertension referral system is a cost-effective way to screen asymptomatic subjects with elevated blood pressures in the accident and emergency department.
Accident and Emergency Department, North District Hospital, Sheung Shui, Hong Kong. tch654@gmail.com
Ludwig C H
LC
Tsoi
Cora C H
CC
Tung
Eliza L Y
EL
Wong
D000328:Adult; D001794:Blood Pressure; D001795:Blood Pressure Determination; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000451:nursing*; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000451:nursing*; D009726:Nurses; D011320:Primary Health Care; D012017:Referral and Consultation