Recognition and Response to Postpartum Preeclampsia in the Emergency Department

The 2020 Texas Maternal Mortality and Morbidity Review Committee (MMMRC) and Texas Department of State Health Services (DSHS) joint biennial legislative report found that 11% of pregnancy–related deaths reviewed by the MMMRC were due to preeclampsia and eclampsia, and 50% of these deaths occurred within 42 days of delivery.   

In its most recent report (2022), the MMMRC found that severe maternal morbidity increased significantly in recent years, rising from 58.2 cases per 10,000 deliveries in 2018 to 72.7 in 2020. Black women were much more likely to experience severe complications than other racial and ethnic groups. The report recommended optimizing coordination between emergency and maternal health services and incorporating emergency department (ED) representation in existing maternal health and safety programs to help prevent pregnancy-related deaths.  

TCHMB’s Recognition and Response to Postpartum Preeclampsia in the Emergency Department (PPED) project aims to reduce maternal morbidity and mortality related to severe hypertension in postpartum patients by: 

  1. Identifying postpartum patients presenting to the Emergency Department (ED) with severe hypertension or preeclampsia
  2. Treating patients identified with severe hypertension in a timely fashion
  3. Improving communication and coordination of care between Emergency Medicine and Obstetric health care teams
  4. Reducing complications from postpartum preeclampsia that led to maternal morbidity and mortality
  5. Reducing racial disparities in health outcomes of Black postpartum patients with severe hypertension or preeclampsia
 
 

Project Timeline

 

Project Updates 

Project Details:

  • Frequently asked questions (link to FAQ document) 

  • Project Participation (link to Project Participation document with enrollment charts and figures) 

Blogs and newsletters  

 

Project Resources and Documents 

Education Tools 

  • Identifying postpartum patients  

    • Questionnaire (link to ED Pilot_Identifying Postpartum Patients document) 

    • Signage (link to signage document) 

  • Incorporating patient perspective 

    • IPFCC Partnering with Patients and Families to Accelerate Improvement Readiness Assessment tool (link to IPFCC Partnering with Patients and Families to Accelerate Improvement Readiness Assessment document) 

    • IPFCC Patient and Family Involvement in Quality Improvement – Planning Exercise (link to IPFCC Patient and Family Involvement in Quality Improvement – Planning Exercise) 

    • ED Nurse Onboarding Packet (link to Float Staff document – take out identifiable information first) 

    • Implicit Bias Training 

  • QI Tools 

    • Change Driver Diagram (link to final version of change driver diagram – follow up with Dr. Eppes on resources section under “When consulting with OB provider or next level of care when care escalates). 

  • Project Reinforcement Calls 

    • March 2023 (Presentation) 

    • April 2023 (Presentation, Video clip – embed to website? Description - “At the April reinforcement call, participating hospitals heard how Titus Regional Medical Center’s OB department is partnering with the emergency department. Listen for tips and tricks on creating an effective partnership between the two departments.” Time stamp - 20:17 to 36:55) 

    • May 2023 (Presentation, Video clip – embed to website? Description - “Hear about South Texas Health System McAllen’s ED simulation success story!” Time stamp - 5:11 to 13:02) Description - “Participating hospitals also got to hear a preeclampsia patient share her birthing story and tips for including the patient perspective in quality improvement efforts” Time stamp - 22:55 to 46:11) 

    • June 2023 (Presentation, Video clip – embed to website? Description - “Listen to Ascension Seton Medical Center Austin share the education they do with their emergency department.” Time Stamp - 9:37 to 22:45) 

 

Leadership

Project Workgroup Lead:

  • Anita Chary, MD, PhD, Ben Taub

OB Committee Co-Chairs:

UT System Project Lead:

  • Mercy Muyia, MPA, UT Health Science Center at Tyler, Affiliate of The University of Texas System