Nurse-led hypertension referral system in an emergency department for asymptomatic elevated blood pressure.

OBJECTIVES

To determine the characteristics of asymptomatic elevated blood pressure patients in an accident and emergency setting and assess the effect of a nurse-led intervention system.

DESIGN

Cross-sectional study.

SETTING

Accident and Emergency Department of a regional hospital in Hong Kong.

PARTICIPANTS

Patients with blood pressures of 140/90 mm Hg or above recorded twice (at triage and discharge) with no previous history of hypertension. Exclusion criteria were: (1) admission to hospital; (2) known hypertension; (3) referral for hypertension; (4) blood pressure higher than 180/120 mm Hg on rechecking.

INTERVENTION

Patients were issued a referral by the discharge nurse to follow-up for blood pressure monitoring in primary care.

MAIN OUTCOME MEASURES

Diagnosis of hypertension, follow-up rate, and risk factors of hypertension.

RESULTS

Of 245 patients with asymptomatic elevated blood pressure, we were able to contact 222 for follow-up, of whom 136 (61%) claimed to have been followed up for their blood pressure, and 48 (22%) were diagnosed to have hypertension. The nurse time for finding one case was 28 minutes. The projected impact could be large. If this simple nursing guideline is implemented territory-wide, more than 7000 new cases of asymptomatic hypertension might be picked up annually.

CONCLUSION

The implementation of a simple nurse-led hypertension referral system is a cost-effective way to screen asymptomatic subjects with elevated blood pressures in the accident and emergency department.