Improving Blood Pressure Screening in Neonatal Follow-up Clinic: A Quality Improvement Initiative

Abstract

Introduction: The American Academy of Pediatrics recommends blood pressure screening at every health care encounter in children younger than 3 years if they have a history of prematurity or other neonatal complications requiring intensive care because these children have an increased risk for hypertension.

Methods: A multidisciplinary team conducted a quality improvement initiative to improve blood pressure screening at a single-center outpatient neonatal follow-up clinic. We developed a focused intervention program including a standardized blood pressure measurement protocol, staff training and education, and streamlined documentation. We conducted two Plan-Do-Study-Act cycles from November 2019 to January 2021. The outcome measure was the percentage of patients with a blood pressure measurement. Process measures included the percentage of medical assistants educated on the new protocol, percentage of patients 3 years, and younger old with the first blood pressure measurement taken from the right arm, and the percentage of patients 1 year and younger with 3 documented blood pressures. The balancing measure was staff satisfaction with time to obtain vital signs. We used statistical process control charts and Wilcoxon rank-sum test.

Results: At baseline, only 15.3% of patients had documented blood pressure. During the 10-month intervention period, there were 954 patient visits. Overall, blood pressure measurement increased to 54.7% with study interventions. The balancing measure was not negatively impacted.

Conclusions: After implementing a program of focused interventions, we substantially improved the frequency of blood pressure measurements and increased adherence to American Academy of Pediatrics screening guidelines. Improved blood pressure screening allows us to identify and evaluate at-risk infants after hospital discharge.

Fig. 1.

Key driver diagram detailing the outcome measure, drivers, and interventions for the project.

Fig. 2.

Process map detailing the standardized blood pressure measurement protocol for the follow-up clinic established by the team.

Fig. 3.

Control chart of the primary outcome, January 2019 to January 2021. LCL, lower control limit; UCL, upper control limit.

Fig. 4.

Control chart of the percentage of patients 3 years and younger old with the first blood pressure measurement taken from the right arm, January 2019 to January 2021. LCL, lower control limit; UCL, upper control limit.