Improving the Bilirubin Management Program in the Newborn Nursery: Background, Aims, and Protocol
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Published on: August 19, 2020
Timothy M Bahr1, Julie H Shakib2, Carole H Stipelman2
1Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA, tim.bahr@imail.org.
Insights
Newborn hyperbilirubinemia management varies widely. A quality improvement program will test changes to improve detection and treatment, aiming for safer, more cost-effective care and reduced hospital readmissions for jaundice.
Area of Science:
- Neonatal care
- Pediatric quality improvement
- Bilirubin metabolism
Background:
- Current practices for detecting and managing newborn hyperbilirubinemia (jaundice) are inconsistent.
- Published guidelines have led to varied approaches, potentially impacting care quality and cost.
- There is a need for evidence-based, standardized methods to reduce emergency room visits and hospital readmissions for jaundice.
Purpose of the Study:
- To implement and evaluate a prospective quality improvement program for newborn hyperbilirubinemia management.
- To assess the value of specific changes in diagnosis, safety, outcomes, and cost related to jaundice care.
- To gather data for developing new evidence-based strategies for neonatal jaundice.
Main Methods:
- Utilizing existing data from approximately 400,000 well infants within the Intermountain Healthcare system.
- Conducting a pre- versus post-practice change analysis to assess specific outcomes.
- Implementing changes in the University of Utah Newborn Nursery during 2020.
Main Results:
- The study aims to identify perceived problems in current bilirubin management systems through stakeholder input.
- Analysis will focus on the feasibility and effectiveness of proposed changes.
- Data will inform the development of improved jaundice management protocols.
Conclusions:
- The quality improvement project is expected to yield insights into optimizing newborn hyperbilirubinemia care.
- Findings will contribute to establishing uniform, safe, and cost-effective strategies for managing neonatal jaundice.
- The ultimate goal is to reduce emergency interventions and hospital readmissions associated with jaundice and prevent bilirubin encephalopathy.
Background:
Practices to detect and manage hyperbilirubinemia in newborn nurseries are highly variable. American Academy of Pediatrics guidelines in 1999, 2004, and 2009 have generated, perhaps unintentionally, divergent practices that might not all be of equivalent value. Evidence-based progress is needed to define less invasive, less expensive, uniform, and safe methods to reduce ER visits and hospital readmissions for jaundice treatment and bilirubin encephalopathy.
Objectives:
This research briefing is intended to inform readers of a new prospective quality improvement program aimed at testing the value of specific changes in newborn nursery hyperbilirubinemia detection and management. This new program includes predetermined means of assessing those specific changes, which relate to diagnosis, safety, outcomes, and cost.
Methods:
In this briefing, we present the perceived problems in our present bilirubin management system, as voiced by stakeholders. We report our proposed means to test minimization of those problems utilizing already acquired data on approximately 400,000 well babies in the Intermountain Healthcare system of hospitals in the western USA. We then describe our methods of assessing specific outcomes in a pre- versus postpractice change analysis.
Results And Conclusions:
The University of Utah Newborn Nursery will implement a quality improvement project in bilirubin management during 2020 to test the feasibility and effectiveness of several changes to our current bilirubin management program. We maintain that the improved understanding generated by this project will be a step toward new evidence-based strategies for reducing ER visits and hospital readmissions for jaundice treatment and preventing bilirubin encephalopathy.
