Development of a care model of hypertensive crisis, Yang Sisurat District, Maha Sarakham Province.

Abstract

      This study aimed to develop a comprehensive care model for patients with hypertensive crisis across pre-hospital and in-hospital settings. Two developmental cycles were implemented to establish the care model. The process involved exchanging knowledge within the organization and tailoring it to the local context. Key components included blood pressure assessment, timely reassessment of complications and the establishment of a fast-track communication and referral system from Subdistrict health promoting hospitals, and guidelines for patient management during transport. In the emergency department, care pathways were developed for the management of emergencies and hypertensive urgencies, including both pharmacologic and non-pharmacologic interventions, as well as monitoring and risk assessment for recurrent complications.

      The results showed a 14.8% increase in patients receiving goal-directed care (95% CI: 3.6755–25.8034, p = .009), a 38.80% reduction in misclassification among hypertensive patients (95%CI 27.181 - 49.150, p <.0001), and an 11.2% increase in referrals via the emergency medical services system (95% CI: –0.4748–22.1605, p = .06). Compliance with clinical practice guidelines among nurses increased by 85% (x̄ = 15.55, SD = 2.14, p < .001).