The High-Risk Postpartum Transitional Program: A Multidisciplinary Approach to Caring for Postpartum Woman With Hypertensive Disease

Preeclampsia complicates 5% to 8% of all pregnancies, is the second leading cause of maternal death in the United States, and a common cause of unplanned postpartum hospital readmissions. Women with perinatal hypertensive disease are also at increased risk of future cardiovascular disease. The High-Risk Postpartum Transitional Program targets postpartum women at risk of persistent hypertensive disease and includes women with the diagnoses of preeclampsia, eclampsia, hemolysis, elevated liver enzymes, and low platelet counts (HELLP), gestational hypertension, and chronic hypertension. The purpose and goal of the program is to standardize care for postpartum women with hypertensive disease, decrease postpartum morbidity, and decrease hospital readmissions related to hypertension. A multidisciplinary team developed a standardized clinical protocol that addressed surveillance, treatment, education, and follow-up across the continuum from identification through delivery and beyond discharge. Identified patients received education about their disease, future health implications, lifestyle modifications, and medication education if appropriate. Home care blood pressure (BP) and symptom monitoring was arranged, and an appointment was made for the patient to return within 2 weeks to the High-Risk Postpartum Transitional Clinic. A follow-up phone call was made before the appointment as reinforcement. Overall readmission rates for patients involved in the High-Risk Postpartum Transitional Program have decreased since it was initiated in the summer of 2012. Recently, we initiated follow-up telephone calls with the goal of bolstering the current clinic admittance rate of 45% to 60%. Our multidisciplinary Unit-Based Clinical Leadership is exploring additional strategies that will enable us to serve more women through partnerships with community outreach programs and additional home care agencies. As primary coordinators of postpartum care, the nurses’ role is a critical factor in its development, implementation, and success. Postpartum clinical nurses educate these women about their disease and its effect on future health, and consult with other professional disciplines such as social work and the unit-based clinical pharmacist to provide additional resources. Unit-based clinical resource coordinator nurses arrange postdischarge home care nursing services for BP and symptom monitoring and women's health nurse practitioners offer inpatient support and a mechanism for hom