Abstract Body: Introduction: Asymptomatic hypertension is common among emergency department (ED) patients. However, follow-up occurs infrequently. Because recognition of elevated readings is a prerequisite for referrals, we investigated the factors associated with the documentation of discussion of elevated BP in provider notes.
Methods: We used electronic medical record data to identify patients who had an outpatient ED, primary care, or urgent care visit with elevated BP (>=140/90 mm Hg) and no prior hypertension diagnosis, 2017-2021. We calculated the percentage of visits in which provider clinical and/or discharge notes mentioned hypertension or elevated BP, beyond the reporting of vitals. We modeled the probability that the notes mentioned elevated BP or hypertension. Covariates included the busyness of the care setting at the time of the visit, patient demographics, visit vitals, and diagnoses.
Results: We identified 13,777 distinct patients with 18,036 ED visits, 3,563 urgent care visits, and 27,895 primary care visits with elevated BP levels. BP was discussed in the notes for 27% of ED visits compared to 51.4% of primary care and 51.1% of urgent care visits. The probability of mentioning BP did not rise with the degree of BP elevation for ED visits, but it did for primary care and urgent care visits (See Figure). Elevated BP was more likely to be discussed in the notes of ED visits when the visit was related to a cardiac complaint, when elevated BP was mentioned in previous notes, and when the ED was less busy than normal.
Conclusions: Elevated BP levels are frequently not discussed in ED clinical notes. Discussions of BP measurements in notes may be an easy-to-measure marker for clinical recognition of elevated BP measurements.