Reduction of Intravenous Antihypertensives through Clinical Decision Support in a Large Safety Net System

Mona Krouss, Surafel Tsega, Daniel Alaiev, Joseph Talledo, Komal Chandra, Peter Alarcon Manchego, Milana Zaurova, Dawi Shin, Mariely Garcia, Hyung J. Cho

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Asymptomatic severe hypertension (also known as hypertensive urgency) is frequently encountered in the hospital. Previous evidence suggests that management with one-time doses of intravenous (IV) antihypertensives may increase adverse events. Despite this, single-dose treatment remains common in the emergency department and inpatient settings. Methods: This quality initiative was launched at New York City Health + Hospitals, the largest safety net hospital system in the United States. The initiative involved two changes to electronic orders for IV hydralazine and IV labetalol: a nonintrusive advisory statement within the order instructions and a mandatory requirement to document the indication for IV antihypertensive use. Results: This initiative took place from November 2021 to October 2022. Of the indications selected for IV antihypertensive orders, 60.7% were for hypertensive emergency, 15.3% were for patients who were strictly NPO, 21.2% were for other, and 2.8% selected more than one indication. For ED-only encounters, aggregate IV hydralazine and IV labetalol orders per 1,000 patient encounters were 2.53 preintervention and 1.55 postintervention (38.7% reduction, p < 0.001). For inpatient encounters, aggregate IV hydralazine and IV labetalol orders per 1,000 patient-days were 18.25 preintervention and 15.81 postintervention (13.4% reduction, p < 0.001). Similar trends were observed for individual orders of IV hydralazine and IV labetalol. There were significant reductions in 7 of the 11 hospitals in inpatient administration of aggregate IV hydralazine and labetalol orders per 1,000 patient-days. Conclusion: This quality improvement initiative successfully reduced unnecessary IV antihypertensive use in an 11-hospital safety net system.

Original languageEnglish
Pages (from-to)291-296
Number of pages6
JournalJoint Commission Journal on Quality and Patient Safety
Volume49
Issue number6-7
DOIs
StatePublished - 1 Jun 2023

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