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

Hong Kong Med J. 2012 Jun;18(3):201-6.


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.

MeSH terms

  • Adult
  • Blood Pressure
  • Blood Pressure Determination
  • Cost-Benefit Analysis
  • Cross-Sectional Studies
  • Emergency Service, Hospital
  • Female
  • Follow-Up Studies
  • Hong Kong
  • Humans
  • Hypertension / diagnosis
  • Hypertension / nursing*
  • Male
  • Mass Screening / economics
  • Mass Screening / nursing*
  • Nurses
  • Primary Health Care
  • Referral and Consultation*