pregnant women in hospital gown holding baby

A multidisciplinary team at Loma Linda University Health has developed a semi-automated care pathway that significantly decreases time to treatment of severe high blood pressure in pregnant women, lowering numbers of morbidity and mortality and potentially reducing disparities in care.

The new care paradigm — using a semiautonomous treatment algorithm — is a nurse-led process that relies on a patient’s electronic medical record (EMR) and artificial intelligence to reduce the time needed to administer appropriate medication.

The algorithm was part of a three-year study, “Semiautonomous Treatment Algorithm for the Management of Severe Hypertension in Pregnancy,” published in the February 2021 issue of Obstetrics & Gynecology journal.

Early medical intervention of high blood pressure disorders in pregnancies is crucial for the health and safety of pregnant women, according to Courtney Martin, DO, medical director of maternity services and co-author of the study.

While algorithms have been effectively used in treating other conditions, Martin said the use of these algorithms in maternity care is not common and would improve maternal outcomes involving hypertensive disorders if used in routine obstetric practice. The process could especially benefit patients of minority communities, she said.

“Although most developed countries have had declines in maternal mortality, the United States continues to have increases, with a large proportion being preventable and in non-Hispanic Black individuals,” Martin said. “The cause of the rise in maternal mortality is multifactorial, and we believe it to be related to advancing maternal age, medical comorbidities, and possibly lack of safety infrastructure across hospital systems designed specifically for pregnant women.” 

The new care pathway works as such: a patient’s blood pressure numbers are entered into their electronic medical records. Then a range of high blood pressures entered into the EMRs trigger the semiautonomous treatment algorithm, providing instantaneous treatment recommendations and medication orders to nursing staff, decreasing delays and standardizing care.

The new process involves teams in obstetrics and maternal fetal medicine, information systems (IS), and patient safety and reliability (PSRC).

“Our algorithm is scalable and side-steps implicit biases, using objective ways to get women the medications they need,” Martin said.

According to the American College of Obstetricians and Gynecologists (ACOG), hypertensive — high blood pressure — disorders of pregnancy complicate approximately 20% of pregnancies, contributing significantly to severe diseases or medical conditions and death. Because of the risks of hypertensive issues within pregnancies, ACOG recommends the treatment of severe high blood pressure within 30 to 60 minutes after diagnosis. However, other medical studies have shown that approximately only 50% of women are treated within this timeframe due to numerous factors.

“Our care pathway reduced time to administration of blood pressure medication that was statistically significant and sustained,” Martin said. “This reduction was accomplished at a tertiary care facility with 24-hour in-house OB physicians, where we already met the 60-minute goal regularly. Implementation of the nurse driven semi-automated component significantly reduced the time to medication by eliminating barriers to care and trusting the artificial intelligence the EMR can provide.” 

In an accompanying editorial to the original research, Alisse Hauspurg, MD, a maternal fetal medicine specialist at Magee-Women’s Hospital of University of Pittsburgh Medical Center, said that implementation nationwide of such an algorithm could “reduce delays in treatment and prevent hypertension-related morbidities.” Additionally, Hauspurg said “innovative approaches” like the algorithm could help in moving past biases, paving the way for more impartial care and providing safer and healthier outcomes for pregnant women in the United States. 

“We need a revolution of innovation in maternity care that can be extended to all women across the country,” Martin said. “This can only be done through innovation, teamwork and a willingness of institutions to support this important work both theoretically and financially like Loma Linda University Health. Our belief is that no child should ever go home from the hospital without a mother — and these pathways are a step closer to establishing framework to hopefully make that a reality across the country for all women.”

Loma Linda University Health’s maternity services, IS and PSRC teams are currently working on a semi-automated care pathway for maternal sepsis and have plans to develop further care pathways for maternal hemorrhage, and other obstetric conditions. 

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