Improving Acute Hypertension Management Through Emergency Department Checklist
Improving Acute Hypertension Management Through Emergency Department Checklist
The investigators hypothesize that the implementation of a checklist in acute severe
 hypertension would result in improving short and long-term outcomes of patients with acute
 severe hypertension treated in the emergency department (ED). The investigators hypothesize
 that in the short-term, a checklist would improve the diagnosis and management of end-organ
 damage as well as reduce the length of stay of acute severe hypertensive patients in the ED.
 The investigators hypothesize that the checklist will result in better compliance with
 anti-hypertensive medications than without the checklist at six-month post-discharge.
Hypertension is a global public health issue and results in over 10 million deaths every
 year. The disease affects one-third of people living in low- and middle-income countries
 (LMICs) and contributes to half of all productivity losses in LMICs due to non-communicable
 diseases. Though hypertension often presents as a chronic asymptomatic illness,
 hypertension-related emergencies represent a significant burden to the health care system.
 Acute severe hypertension [i.e., systolic blood pressure (SBP) ≥ 180 mmHg or diastolic blood
 pressure (DBP) ≥ 110 mmHg] make up to 5% of all emergency admission. One-third of these
 patients present with end-organ damage; a condition called a hypertensive crisis. More
 worrisome is the fact that a number of ED visits, as a result, severe acute hypertension and
 hypertensive crises have almost tripled between 2006 and 2013 in the US. Treatment approaches
 to managing acute severe hypertension (~5% of ED patients) are largely unclear and only 6% of
 ED patients with acute severe hypertension receive appropriate work-up for the end-organ
 damage, indicating a huge care gap. One approach, which has been used successfully in
 managing other complex and critical conditions, is the use of checklists. Checklists are a
 listing of actions to be performed in a given clinical setting with the aim of improving
 adherence to standards, reducing errors and thus improving patient outcomes. The
 investigators hypothesize that the use of a Checklist, if appropriately implemented, can lead
 to an improvement in the care of patients presenting with hypertensive crisis. During this
 study, the investigators will measure the prevalence of acute severe hypertension and assess
 the current quality of care for these patients. This will be followed by the development of a
 checklist for the management of the hypertensive crises in the ED. The investigators will
 follow these patients to see the impact of the checklist on the quality of care and long-term
 outcomes.
Inclusion Criteria:

 -  Adults who visit the Aga Khan University Hospital Emergency Department with acute
 severe hypertension

 -  able to provide consent to participate

 -  Age >25 years of age

 -  Meeting the criteria of acute severe hypertension (SBP>180 and DBP>110).

 Exclusion Criteria:

 -  Patients not providing consent or are unconscious are excluded from participation.