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.