(1060) Postpartum readmission rates after implementation of a standardized furosemide protocol.

While the utilization of a standardized protocol for postpartum furosemide administration among subjects with hypertensive disorders of pregnancy (HDP) is suggested to reduce postpartum readmission rates, implementation of a protocol on open labor & deliveries can be challenging. We succeeded in implementing this protocol in our high risk urban cohort in a single hospital in our system. We sought to evaluate rates of postpartum readmission before and after protocol implementation.

Study Design:

In October of 2022, a standardized protocol for postpartum furosemide administration was approved and implemented in our institutional hospital labor & delivery. This study was a retrospective chart review of postpartum patients who delivered within that hospital system and were diagnosed with HDP. The study period prior to intervention was 10/2020-10/2022 and the post was 10/2022-10/2024.

Results:
Of a total of 18,984 patients who delivered between October 2020 and October 2024, 4,967 patients had a diagnosis of HDP (26%). The was no difference in the two groups (pre-intervention and post-intervention) with regards to age, race, gestational age at delivery, and HDP diagnosis [Table 1a]. The implementation of the protocol significantly reduced postpartum readmission rates within the first 7 days, 4.2% pre and 2.8% post (P=0.008) [Table 1b]. Furthermore, postpartum readmission rates within 30, 42, 60 and 90 days continued to show a downward trend after the implementation of the protocol.

Conclusion:

On October 1, 2022, a standardized furosemide administration protocol was implemented at a large urban academic hospital. Since its initiation, the rates of postpartum readmission have decreased significantly. Further studies can now be performed to look specifically as to postpartum antihypertensive medication usage, and whether furosemide decreases the need for anti-hypertensive therapy. In addition, this study did not look at adverse events after administration of furosemide. Although thought to be rare, this should be analyzed for safety data.