Client: Obstetricians and other clinicians affiliated with 32 birthing hospitals participating in a perinatal quality collaborative.

Challenge: In Maryland, hypertensive disorder of pregnancy is the third leading cause of severe maternal morbidity, and accounts for over 8% of pregnancy-related deaths. Black individuals are significantly more likely to experience high blood pressure during pregnancy and have higher maternal morbidity and mortality rates. A contributing factor is that not all providers have reliable, evidence-based processes in place to address dangerously elevated blood pressure during pregnancy and in the postpartum period.

Solution:  In January 2021, the Maryland Perinatal-Neonatal Quality Collaborative (MDPQC) began implementing the Alliance for Innovation on Maternal Health’s (AIM) severe hypertension in pregnancy patient safety bundle. HQI produced trainings, facilitated peer-to-peer learning, analyzed data and offered resources for bundle implementation, which promotes treatment of severe hypertension within 60 minutes of onset by removing barriers to rapid administration of anti-hypertensives and magnesium sulfate therapy.

Results: All birthing hospitals in the state implemented the AIM bundle, which has increased access to potentially life-saving care for pregnant people with severe hypertension. Since implementation, indicators across all structure measures have improved. The number of Maryland hospitals integrating bundle processes into their hospital’s electronic health record system increased from 53% to 84%. Additionally, as a result of bundle implementation, the percentage of clinicians receiving severe hypertension/preeclampsia education increased from 62.5% to 85.5% in providers and 79.8% to 91.8% in nurses. Also, the percentage of patients with a sustained severe hypertensive episode who received timely treatment, within 60 minutes of diagnosis, increased from 41% to 64.3% during the project period.

Sponsor:  This project is funded by the Maryland Department of Health (MDH) and is one of two initiatives underway through the Maryland Perinatal-Neonatal Quality Collaborative, which HQI manages on MDH’s behalf.