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Clinical decision support tool for phototherapy initiation in preterm infants
Yassar Arain1,2, Juan M Banda3,4, Joshua Faulkenberry5
1Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
Insights
Implementing an electronic health record tool improved phototherapy guideline adherence in preterm infants. This clinical decision support (CDS) tool increased adherence by 77% without causing adverse events.
Area of Science:
- Neonatal Medicine
- Clinical Informatics
- Pediatric Healthcare
Background:
- Phototherapy is crucial for managing hyperbilirubinemia in preterm infants.
- Initial adherence to phototherapy guidelines in academic NICUs was suboptimal (39%), with many infants receiving treatment below recommended total bilirubin (TB) thresholds.
Purpose of the Study:
- To evaluate the impact of a novel electronic health record integrated clinical decision support (CDS) tool on phototherapy initiation adherence in preterm infants.
- To determine if the CDS tool improved the proportion of phototherapy initiations consistent with recommended TB thresholds.
Main Methods:
- Development and implementation of Premie BiliRecs (PBR), a CDS tool for preterm infants (27-34 weeks postmenstrual age).
- Primary outcome: proportion of phototherapy initiation events aligned with recommended TB thresholds.
Main Results:
- Adherence to phototherapy guidelines significantly increased to 69.8% (p < 0.001) after PBR implementation, a 77% improvement.
- No significant increase in severe hyperbilirubinemia or the need for exchange transfusions was observed.
Conclusions:
- The Premie BiliRecs (PBR) CDS tool effectively improved adherence to phototherapy guidelines in preterm infants.
- The adoption of PBR enhanced guideline adherence without compromising infant safety or increasing adverse events.
Objective:
Adherence to guidelines for phototherapy initiation in preterm infants was 39% in our academic NICU (61% of phototherapy was initiated at total bilirubin (TB) levels below recommended thresholds). We hypothesized that adoption of an electronic health record integrated clinical decision support (CDS) tool would improve adherence to phototherapy guidelines.
Study Design:
We developed and implemented Premie BiliRecs (PBR), a novel CDS tool for phototherapy initiation in preterm infants from 27 through 34 weeks postmenstrual age. The primary outcome measure was the proportion of phototherapy initiation events consistent with recommended TB thresholds.
Result:
Following the implementation of PBR, adherence to guidelines for phototherapy initiation in preterm infants increased to 69.8% (p < 0.001), an improvement of 77%. There was no increase in the incidence of severe hyperbilirubinemia nor exchange transfusions.
Conclusion:
The adoption of PBR was associated with improved adherence to phototherapy guidelines in preterm infants without increased adverse events.
