{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:22:41Z","timestamp":1787772161431,"version":"build-2784847793"},"reference-count":9,"publisher":"Georg Thieme Verlag KG","issue":"04","funder":[{"name":"Collaborative for Healthcare Delivery Science (CHDS), which is funded by the Advancing a Healthier Wisconsin Research & Education Program and Medical College of Wisconsin Dean\u2019s Office","award":["3600"],"award-info":[{"award-number":["3600"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>\n            Objective\u2003Hypertensive disorders of pregnancy, defined as chronic (&lt;20 weeks) or gestational (&gt;20 weeks), are a leading cause of pregnancy-related mortality in the United States. Hypertensive disorders of pregnancy had increased prevalence from 13.3 to 15.9% among delivery hospitalizations between 2017 and 2019. The objective of this project was to increase the percentage of obstetric patients with hypertensive emergency who received evidence-based treatment within 60\u2009minutes at a single academic center.<\/jats:p><jats:p>\n            Study Design\u2003Data were collected before and after the implementation of a hypertension patient safety bundle. Each occurrence of hypertensive emergency was assessed to determine if evidence-based intervention occurred within 60\u2009minutes, and if the intervention steps were successfully followed. Bundle implementation included creation of a standardized order set and interdisciplinary team-based simulations. Baseline data compared 250 preimplementation to 250 postimplementation interventions. The quality improvement interdisciplinary team reevaluated data monthly and incorporated process improvements through Plan-Do-Study-Act (PDSA) cycles to achieve a goal of 80% of patients receiving evidence-based treatment within 60\u2009minutes.<\/jats:p><jats:p>\n            Results\u2003A total of 1,025 hypertensive emergencies were identified in 543 patients. Prior to the protocol on average 64% of patients received evidence-based, timely treatment. After implementation of this bundle and several PDSA cycles, we sustained &gt;80% of patients receiving target treatment for the final 6 months of data collection. The leading deviations were \u201cno medication given\u201d and \u201cincorrect medication.\u201d Improvements in order set accessibility and repeated team-based trainings led to improvement in these identified protocol deviations.<\/jats:p><jats:p>\n            Conclusion\u2003Implementation of a patient safety bundle led to a sustained 6-month improvement in the percentage of patients receiving appropriate treatment of obstetric hypertensive emergency within 60\u2009minutes of the first severe hypertension measurement. Processes that may have helped achieve this outcome included standardized order sets, team awareness of institutional data, and team-based simulations.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2404-4676","type":"journal-article","created":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T23:35:36Z","timestamp":1724974536000},"page":"452-461","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Patient Safety Bundle and Team-Based Training on Obstetric Hypertensive Emergencies"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6136-1032","authenticated-orcid":false,"given":"Laura","family":"Grogan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Flatley","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Froedtert Hospital and Clinics, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Domeyer-Klenske","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,9,19]]},"reference":[{"issue":"17","key":"ref1","doi-asserted-by":"crossref","first-page":"585","DOI":"10.15585\/mmwr.mm7117a1","article-title":"Hypertensive disorders in pregnancy and mortality at delivery hospitalization - United States, 2017-2019","volume":"71","author":"N D Ford","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/AOG.0000000000001810","article-title":"Factors underlying the temporal increase in maternal mortality in the United States","volume":"129","author":"K S Joseph","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref3","first-page":"215","article-title":"Severe maternal morbidity during delivery hospitalizations","volume":"116","author":"C Gibson","year":"2017","journal-title":"WMJ"},{"issue":"18","key":"ref4","doi-asserted-by":"crossref","first-page":"423","DOI":"10.15585\/mmwr.mm6818e1","article-title":"Vital signs: pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 states, 2013-2017","volume":"68","author":"E E Petersen","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1097\/AOG.0000000000000746","article-title":"Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities","volume":"125","author":"E K Main","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"e212","DOI":"10.1055\/s-0038-1673632","article-title":"Safe motherhood initiative: early impact of severe hypertension in pregnancy bundle implementation","volume":"8","author":"L L Simpson","year":"2018","journal-title":"AJP Rep"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1007\/s10995-013-1267-0","article-title":"California Pregnancy-Associated Mortality Review: mixed methods approach for improved case identification, cause of death analyses and translation of findings","volume":"18","author":"C Mitchell","year":"2014","journal-title":"Matern Child Health J"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1097\/AOG.0000000000000219","article-title":"The national partnership for maternal safety","volume":"123","author":"M E D'Alton","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1097\/AOG.0000000000003290","article-title":"Systolic hypertension, preeclampsia-related mortality, and stroke in California","volume":"133","author":"A E Judy","year":"2019","journal-title":"Obstet Gynecol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2404-4676.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T23:31:32Z","timestamp":1740439892000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2404-4676"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,29]]},"references-count":9,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2025,2,24]]},"published-print":{"date-parts":[[2025,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2404-4676","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,8,29]]},"published":{"date-parts":[[2024,8,29]]}}}