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Management of neonates with hyperbilirubinemia: improving timeliness of care using a clinical pathway

Margaret Wolff1, Dana Aronson Schinasi, Jane Lavelle

  • 1Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109, USA. wolffm@med.umich.edu

Pediatrics
|November 14, 2012
PubMed

Insights

Implementing a nursing-initiated clinical pathway significantly reduced treatment times for neonatal hyperbilirubinemia in the emergency department (ED), improving care efficiency for jaundiced newborns.

Area of Science:

  • Pediatrics
  • Emergency Medicine
  • Neonatal Care

Background:

  • Neonatal hyperbilirubinemia is a frequent cause for emergency department (ED) visits.
  • Existing clinical guidelines for jaundice management lack sufficient ED-specific implementation studies.
  • The study addresses the need for effective strategies in managing neonatal jaundice within the ED.

Purpose of the Study:

  • To evaluate the impact of a nursing-initiated clinical pathway on the time to phototherapy for neonates with jaundice in the ED.
  • To assess secondary outcomes, including time to bilirubin results and ED length of stay.

Main Methods:

  • A retrospective historical control study design was employed.
  • Data were collected from 300 neonates (149 pre-pathway, 151 post-pathway).
  • Chart abstraction focused on assessment, treatment, and disposition times.

Main Results:

  • Median time to phototherapy decreased from 128 to 52 minutes (P < .001).
  • Median time to bilirubin results shortened from 157 to 99 minutes (P < .001).
  • Median ED length of stay reduced from 268 to 195 minutes (P < .001).

Conclusions:

  • Implementation of a clinical pathway streamlined jaundice management in the ED.
  • The pathway led to significant reductions in phototherapy initiation, bilirubin testing, and overall ED stay.
  • No adverse events were reported, indicating safe implementation.
Abstract

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