Use of an Automated Discharge Instruction Module to Improve Outpatient Follow-Up for Emergency Department Patients with Elevated Blood Pressure

High Blood Press Cardiovasc Prev. 2022 Sep;29(5):481-485. doi: 10.1007/s40292-022-00533-6. Epub 2022 Jul 15.

Abstract

Introduction: Hypertension is often incidentally discovered in the emergency department (ED); these patients may benefit from close follow-up. We developed a module to automatically include discharge instructions for patients with elevated blood pressure (BP) in the ED, aiming to improve 30-day follow-up.

Aim: This study sought to determine if automated discharge instructions for patients with elevated blood pressure in the ED improved 30-day follow-up with a patient's primary care physician (PCP).

Methods: We developed an automated module with standardized instructions for patients with elevated BP. These were read upon discharge, and e-mailed to the PCP. We analyzed 193 patients during a 1-month interval after implementation, and 207 during 1-month the year prior. The groups were compared using Fisher's exact test.

Results: Thirty-day follow-up was 52.2% pre-implementation and 48.4% post-implementation, with no significant difference noted. For patients without known hypertension, follow-up slightly improved, but not significantly. For hypertensive patients, follow-up rates significantly decreased post-implementation.

Conclusions: Despite implementation of automated discharge instructions, we found no improvement in 30-day follow-up. Patients without hypertension trended towards improved follow-up, possibly being more attentive to new abnormal BP readings. However, known hypertensive patients followed-up at a lower rate, which was unexpected and requires further investigation.

Keywords: Discharge instructions; Emergency department; Follow-up; Hypertension.

MeSH terms

  • Blood Pressure
  • Emergency Service, Hospital
  • Follow-Up Studies
  • Humans
  • Hypertension* / diagnosis
  • Hypertension* / therapy
  • Outpatients
  • Patient Discharge*