Improving Blood Pressure Accuracy in the Outpatient Adolescent Setting

Area of Science:

• Pediatric Hypertension
• Quality Improvement in Healthcare
• Adolescent Medicine

Background:

• Pediatric hypertension (HTN) is a growing concern, with affected children often becoming hypertensive adults.
• Accurate blood pressure (BP) measurement and timely HTN diagnosis in adolescents are frequently hindered by provider distrust, time constraints, and reluctance to prescribe medication.

Purpose of the Study:

• To enhance blood pressure (BP) measurement accuracy and improve the diagnosis and management of hypertension (HTN) in an adolescent population through a quality improvement project.

Main Methods:

• Interventions included equipment upgrades, process mapping, and staff training on manual/automated BP measurement techniques.
• Implementation of updated best practice alerts (BPAs) integrated with electronic health records, based on age-specific HTN guidelines.
• Educational sessions for faculty and staff on current hypertension guidelines for adolescents.

Main Results:

• Post-intervention, faculty and staff reported increased confidence in BP measurement accuracy.
• A significant decrease in patient visits with elevated BP readings was observed after the interventions.
• Correct diagnoses of elevated BP and appropriate laboratory workups increased, despite minimal use of a new order set.

Conclusions:

• Combining updated equipment, guideline education, and EHR-integrated BPAs can reduce BP measurement errors and improve diagnostic accuracy in ambulatory settings.
• Real-time alerts are effective in improving diagnosis and intervention rates for elevated BP in youth.
• Provider engagement with electronic order sets remains a challenge.