Documentation of high blood pressure measurements in the emergency department: factors associated with discussion and comparison to other settings

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 elevated BP measurements in provider notes. Electronic medical record (EMR) data from the University of Iowa Healthcare system were used to identify patients who had an outpatient ED, primary care, or urgent care visit with high BP (140/90 mmHg or greater) from 01 January 2017 through 31 December 2021 and no prior hypertension diagnosis. We measured whether clinical notes from each visit mentioned hypertension or high BP and modeled the probability of that event across visits in ED, urgent care, and primary care settings. Covariates included the busyness of the care setting at the time of the visit, patient demographics, visit vitals and diagnoses. We identified 13,777 distinct patients with 18,036 ED visits, 3564 urgent care visits, and 27,895 primary care visits. Patient BP was discussed in the notes for 27% of ED visits compared to 51% of visits for both primary and urgent care. High BP was more likely to be mentioned in ED visit notes when the visit included diagnoses indicating chest pain and during times when the ED was substantially less busy than normal. High BP was also more likely to be mentioned in notes of the ED for patients with any prior diagnosis code of nonhypertension-related elevated BP. High BP levels are frequently not discussed in clinical and discharge notes.