Improving Blood Pressure Control Post Emergency Department Visit Through Structured Patient Education and Telephone Follow-up: A Quality Improvement Initiative
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Background
Uncontrolled hypertension frequently persists after emergency department (ED) discharge because of limited education, poor adherence, and fragmented follow-up. This quality improvement initiative evaluated whether structured discharge education plus telephone follow-up could improve blood pressure (BP) and continuity of care.
Methods
A prospective, single-center initiative enrolled 50 consecutive adults with uncontrolled hypertension presenting to an ED in Lahore, Pakistan, from May to July 2026. Participants received standardized counseling on medication adherence, lifestyle modification, BP monitoring, warning symptoms, and primary care follow-up, followed by a structured telephone assessment approximately 2 weeks after discharge. We compared pre- and post-intervention BP values among follow-up completers using a paired-samples t-test; we summarized categorical outcomes as frequencies and percentages.
Results
Of 50 enrolled patients, 38 (76%) completed follow-up, and 12 (24%) were lost to follow-up. Among completers, mean systolic BP decreased from 165.64 ± 19.26 to 143.75 ± 18.52 mmHg and mean diastolic BP decreased from 94.92 ± 7.86 to 84.88 ± 7.47 mmHg (P<0.001). Thirty-seven of 38 completers (97.4%; 74% of all enrolled) demonstrated BP improvement, and 19 of 38 (50%; 38% of all enrolled) achieved BP below 140/90 mmHg. Using the conservative all-enrolled denominator, 58% reported medication adherence, 64% reported lifestyle modification, 48% reported primary care follow-up, and 60% reported symptom improvement.
Conclusion
Structured discharge education with short-term telephone follow-up was associated with clinically and statistically significant BP reductions and improved self-reported care behaviors. This low-cost approach may strengthen transitions from emergency to primary care in resource-limited settings, although loss to follow-up and the absence of a concurrent control group limit causal inference.
