{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T09:36:23Z","timestamp":1793957783339,"version":"4.8.0"},"reference-count":20,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,12]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Hypertensive disorders of pregnancy are a leading cause of pregnancy\u2010related morbidity and mortality. Timely treatment of a hypertensive emergency has the potential to reduce preeclampsia\u2010related morbidity and mortality.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the impact of quality improvement and patient safety initiatives on timely treatment of hypertensive emergencies in pregnancy and racial and ethnic disparities.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Maternity teaching hospital in Texas Medical Center.<\/jats:p>\n <\/jats:sec>\n \n Population<\/jats:title>\n Pregnant and postpartum women with hypertensive emergencies.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective chart review of all hospital deliveries with a hypertensive emergency was conducted from 1 January 2017 through 31 December 2024. During the study period, our hospital implemented a maternal early warning system (MEWS) and a patient safety bundle for severe hypertension (SHTN) in pregnancy. All deliveries \u2265 20 0\/7\u2009weeks were included.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes Measures<\/jats:title>\n Rate of timely treatment of SHTN, overall and by race and ethnicity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n There was a statistically significant improvement in the rate of timely treatment of SHTN with implementation of MEWS (69.5% at baseline\/phase 1 vs. 79.9% with MEWS\/phase 2,\n p<\/jats:italic>\n \u2009<\u20090.001, 15% improvement) and then again with implementation of the SHTN bundle\/phase 3 (88.8% in phase 3, 11% improvement compared to phase 2 and 27.8% improvement compared to phase 1,\n p<\/jats:italic>\n \u2009<\u20090.001). Changes over time within each racial and ethnic group indicated that the rate of timely treatment of a hypertensive emergency increased significantly for NH\u2010Black, NH\u2010White and Hispanic patients from phase 1 to phase 2 and for all groups from phase 1 to phase 3. The disparity in treatment fallouts and timely treatment was eliminated with MEWS modifications and the patient safety bundle in the final phase.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Quality improvement and patient safety efforts that standardise response to and treatment of hypertensive emergencies can lead to improvement in timely treatment and elimination of racial and ethnic disparities.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1471-0528.18273","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T06:53:54Z","timestamp":1752821634000},"page":"2160-2167","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of a Maternal Early Warning System and Severe Hypertension Safety Bundle on Timely Treatment of Hypertensive Emergencies: A Quality Improvement and Health Equity Initiative"],"prefix":"10.1111","volume":"132","author":[{"given":"Towana D.","family":"Sims","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Shubert","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacie","family":"Denning","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Shay","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2010Fetal Medicine Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1773-9296","authenticated-orcid":false,"given":"Celeste","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2010Fetal Medicine Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6143-9442","authenticated-orcid":false,"given":"Christina","family":"Davidson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2010Fetal Medicine Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,17]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Centers for Disease Control and Prevention \u201cPregnancy Mortality Surveillance System \u201d (2020) https:\/\/www.cdc.gov\/reproductivehealth\/maternal\u2010mortality\/pregnancy\u2010mortality\u2010surveillance\u2010system.htm."},{"issue":"17","key":"e_1_2_9_3_1","first-page":"585","article-title":"MMWR Morbidity and Mortality Weekly Report: Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization \u2014 United States, 2017\u20132019","volume":"71","author":"Ford N.","year":"2022","journal-title":"Centers for Disease Control and Prevention"},{"key":"e_1_2_9_4_1","unstructured":"Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services \u201cJoint Biennial Report 2022 \u201d (2022) https:\/\/www.dshs.texas.gov\/sites\/default\/files\/legislative\/2022\u2010Reports\/Joint\u2010Biennial\u2010MMMRC\u2010Report\u20102022.pdf."},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003290"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003892"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.10.007"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000480"},{"key":"e_1_2_9_9_1","unstructured":"\u201cSevere Hypertension in Pregnancy AIM \u201d (2022) https:\/\/saferbirth.org\/psbs\/severe\u2010hypertension\u2010in\u2010pregnancy\/."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004411"},{"key":"e_1_2_9_11_1","unstructured":"Texas DSHS \u201cMaternal Designation \u201d (2023) https:\/\/www.dshs.texas.gov\/."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2021-014225"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.10.007"},{"key":"e_1_2_9_14_1","unstructured":"Centers for Disease Control and Prevention \u201cOffice of Management and Budget (OMB) DIRECTIVE NO. 15 Race and Ethnic Standards for Federal Statistics and Administrative Reporting \u201d (2019) https:\/\/wonder.cdc.gov\/wonder\/help\/populations\/bridged\u2010race\/Directive15.html."},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.01.017"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003667"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.02.009"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.05.012"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.01.154"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004235"},{"key":"e_1_2_9_21_1","article-title":"Diagnosis and Management of Hypertension in Pregnancy: Summary of Updated NICE Guidance","volume":"366","author":"Webster K.","year":"2019","journal-title":"BMJ (Clinical Research Ed.)"}],"container-title":["BJOG: An International Journal of Obstetrics & Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.18273","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T05:36:35Z","timestamp":1762493795000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.18273"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,17]]},"references-count":20,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/1471-0528.18273"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.18273","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,17]]},"assertion":[{"value":"2025-02-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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