Improving Recognition of Inpatient Elevated Blood Pressure in the Pediatric Population

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Elevated blood pressure (EBP) is common in hospitalized pediatric patients and has increased over the past three decades. Unrecognized EBP can lead to significant morbidity and mortality. Inpatient EBP has often been attributed to acute factors such as medications, surgery, anxiety, or illness. However, recent literature shows that EBP during hospitalization predicts persistent outpatient EBP. Timely recognition and communication of inpatient EBP to primary care providers (PCPs) is therefore critical for appropriate follow-up. This quality improvement initiative aims to improve EBP recognition and PCP communication for pediatric patients admitted to the general pediatric hospitalist service at Helen DeVos Children's Hospital. We report findings from the first phase of this multi-phase project evaluating EBP recognition and PCP communication following an educational intervention.

Blood pressure (BP) data from pediatric patients admitted to HDVCH was collected in REDCap. Patients aged 3-18 years admitted for ≤7 days to primary pediatric hospitalist teams were included. Those with known hypertension, kidney disease, or surgical co-management were excluded. Elevated blood pressure (EBP) was defined as BP >90th percentile for age and sex per 2017 AAP guidelines and was further validated by subtracting 10 mmHg from systolic and diastolic values to account for external factors. Residents were instructed to add "elevated blood pressure" to the problem list for patients with ≥3 EBPs during admission. EBP percentiles were generated daily in progress notes and based on 2017 AAP guidelines. Attending physicians communicated EBPs to PCPs at discharge and documented this in their attestation notes. Data from July-December 2025 was retrospectively reviewed over four 4-week cycles to assess EBP prevalence, documentation in patient problem lists, and PCP communication.

Over the course of four 4-week cycles, a total of 289 patients were reviewed. Of these 289 patients, 15 patients were excluded due to not meeting initial inclusion criteria or lacking relevant height data to generate BP percentiles. Of the remaining 274 patients, 41 (15.0%) had at least 3 instances of EBP during their hospitalization. Of these 41 patients with 3 instances of EBP, 10 (24.4%) had "elevated blood pressure" added to their problem list and 5 (12.2%) had their PCP notified. Among the 233 patients with fewer than three documented EBP readings, elevated blood pressure was added to the problem list in 2 patients (0.86%) and PCP notification was documented in 1 patient (0.43%.)

Initial data reveals deficiencies in both recognition and communication of EBP to PCPs. Failure to add EBP to the problem list in over 75% of cases highlights a need for improved inpatient education of EBP among residents. Although communication was expected to be driven by resident documentation, findings indicate that targeted education for attending physicians is also necessary. Future project phases will include additional educational interventions and further retrospective review, with a goal of achieving a 50% rate of EBP recognition and communication.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1994

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