Ensuring safe and equitable discharge: a quality improvement initiative for individuals with hypertensive disorders of pregnancy.



To improve timely and equitable access to postpartum blood pressure (BP) monitoring in individuals with hypertensive disorders of pregnancy (HDP).


A quality improvement initiative was implemented at a large academic medical centre in the USA for postpartum individuals with HDP. The primary aim was to increase completed BP checks within 7 days of hospital discharge from 40% to 70% in people with HDP in 6 months. Secondary aims included improving rates of scheduled visits, completed visits within 3 days for severe HDP and unattended visits. The balancing measure was readmission rate. Statistical process control charts were used, and data were stratified by race and ethnicity. Direct feedback from birthing individuals was obtained through phone interviews with a focus on black birthing people after a racial disparity was noted in unattended visits.


Statistically significant improvements were noted across all measures. Completed and scheduled visits within 7 days of discharge improved from 40% to 76% and 61% to 90%, respectively. Completed visits within 3 days for individuals with severe HDP improved from 9% to 49%. The unattended visit rate was 26% at baseline with non-Hispanic black individuals 2.3 times more likely to experience an unattended visit than non-Hispanic white counterparts. The unattended visit rate decreased to 15% overall with an elimination of disparity. A need for BP devices at discharge and enhanced education for black individuals was identified through patient feedback.


Timely follow-up of postpartum individuals with HDP is challenging and requires modification to our care delivery. A hospital-level quality improvement initiative using birthing individual and frontline feedback is illustrated to improve equitable, person-centred care.





Published Version (Please cite this version)


Publication Info

Zacherl, Kathleen M, Emily Carper Sterrett, Brenna L Hughes, Karley M Whelan, James Tyler-Walker, Samuel T Bauer, Heather C Talley, Laura J Havrilesky, et al. (2024). Ensuring safe and equitable discharge: a quality improvement initiative for individuals with hypertensive disorders of pregnancy. BMJ quality & safety. p. bmjqs-2024-017173. 10.1136/bmjqs-2024-017173 Retrieved from https://hdl.handle.net/10161/30663.

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Emily Sterrett

Associate Professor of Pediatrics

Brenna L Hughes

Professor of Obstetrics and Gynecology

Samuel T Bauer

Associate Professor of Obstetrics and Gynecology

Samuel T. Bauer, MD, MBA, FACHE, CPE, FACOG is a board-certified Maternal-Fetal Medicine specialist through the American Board of Obstetrics and Gynecology and an Associate Professor of Obstetrics and Gynecology, and the Medical Director of Duke Perinatal, Quality, and Digital Health in the Department of Obstetrics and Gynecology at Duke University. Dr. Bauer is a board-certified Fellow of the American College of Healthcare Executives and a Certified Physician Executive through the Certifying Commission in Medical Management. He holds certifications from the Harvard University T.H. Chan School of Public Health in Leadership Development for Physicians in Academic Health Centers and the Columbia Business School in Digital Transformation in Healthcare. His leadership style is grounded in the concepts from the American College of Healthcare Executives, the American Association for Physician Leadership, Duke Clinical Leadership Program, Duke Emerging Leaders Program, and the Beaumont Health Physician Leadership Academy. Dr. Bauer is a certifying oral board examiner for the American Board of Obstetrics and Gynecology and holds Lean Six Sigma Green Belt Certification.

Dr. Bauer has over a decade of healthcare leadership experience and progressively gained health system leadership experience and responsibility at Beaumont Health (now Corewell Health East) in southeast Michigan. As Physician Executive for OB/GYN and Chief for the Women’s and Children’s Clinical Care Program, he was responsible for promoting excellence across all clinical sites, and a key collaborative stakeholder in the creation of the clinical strategic and operational plan for Beaumont Health. He was responsible for portfolio management, operations, credentialing, manpower planning, quality and safety, and supervision of the Beaumont Medical Group, a 1000-physician-strong multi-specialty group. Dr. Bauer represented and navigated the OB/GYN service line through a three-health system merger including 8 hospitals with 7 labor and deliveries, which included approximately 17,500 births, into a single healthcare enterprise. He actively contributed to the development of a single physician contract, a faculty compensation plan, and an integrated care model which combined community and academic medicine. He currently serves as Medical Director of Duke Perinatal, the flagship Maternal-Fetal Medicine clinical site which provides world-class care for high-risk pregnancies and is the busiest of the OB/GYN Department’s 22 ambulatory sites.

As the Duke Health Digital Health Medical Director, Dr. Bauer has a long-standing knowledge of the telemedicine industry as well as digital health implementation experience in health care. Improving health outcomes are dependent upon growing new and innovative healthcare models. Dr. Bauer leads a virtual care expansion program team that includes traditional video consultation, a remote patient monitoring platform, as well as remote synchronous and asynchronous ultrasound interpretation, which extends care throughout North Carolina. He currently leads a system-wide digital strategy team at Duke focused on large language models and AI health related initiatives. 

Dr. Bauer’s research focuses on strategies to reduce maternal morbidity through the establishment of quality metrics and safety bundle implementation. He leads multidisciplinary teams to implement and monitor quality and safety improvement initiatives, policies, and procedures to enhance patient care outcomes in OB/GYN across Duke Health. Dr. Bauer is a peer-nominated committee member of the American College of Obstetricians and Gynecologists Committee for Clinical Practice Guidelines. He is a member of the Society for Maternal-Fetal Medicine (SMFM) Maternal Safety and Quality Committee and Practice Management Advisory Committee, Foundation for SMFM Development Committee, and Chair of the OB/GYN Section of the Core Quality Measures Collaborative, the partnership between American’s Health Insurance Plans and the Centers for Medicare and Medicaid Services, which is housed at the National Quality Forum (NQF). Dr. Bauer is a committee member of the NQF – Measure Applications Partnership Hospital Workgroup, convened by the NQF, in partnership with the Centers for Medicare & Medicaid Services, to provide input to the US Department of Health and Human Services on the selection of performance measures for public reporting and performance-based payment programs. Dr. Bauer is an ACOG Fellow and Physician Champion for the CDC-funded Fetal Alcohol Spectrum Disorder Program.

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