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Deimplementation of Polycythemia Screening in Asymptomatic Infants in a Level 1 Nursery
Scarlett C Johnson1, Elizabeth Bigus1, Patricia L Thompson1
1Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Insights
Screening for polycythemia in asymptomatic newborns was significantly reduced using quality improvement methods. This initiative decreased unnecessary hematocrit screenings without impacting infant outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Healthcare Quality Improvement
Background:
- Polycythemia, defined as venous hematocrit >65%, is uncommon in healthy newborns but can lead to serious complications.
- Current national guidelines do not address screening or management for asymptomatic infants with polycythemia.
- Existing screening protocols for 'high-risk' newborns demonstrated poor adherence and low yield.
Purpose of the Study:
- To decrease polycythemia screening in asymptomatic, high-risk newborns by 80% within six months.
- To evaluate the effectiveness of quality improvement interventions in reducing low-value screening practices.
Main Methods:
- A quality improvement project was implemented at a tertiary children's hospital using the Model for Improvement.
- Interventions included protocol discontinuation, staff education, performance feedback, and visual reminders.
- The primary outcome was the proportion of asymptomatic infants screened; secondary outcomes included costs, length of stay, and clinical outcomes.
Main Results:
- The screening rate for high-risk infants decreased from 80% at baseline to 1% after interventions.
- No cases of symptomatic polycythemia were detected, and there were no significant increases in readmissions or transfers.
- Sustained changes were observed during one month of monitoring.
Conclusions:
- Quality improvement strategies, including education and feedback, can effectively reduce low-value screening practices in neonatal care.
- Deimplementation of unnecessary procedures can be achieved through targeted interventions.
- This approach supports evidence-based practice and resource optimization in newborn care.
Abstract:
Polycythemia (venous hematocrit >65%) is rare in healthy newborns (incidence: 0.4%-5%), with serious outcomes (stroke, bowel ischemia) of unknown incidence in asymptomatic infants. No national guidelines address screening or management of asymptomatic infants with polycythemia. Our nursery screened "high risk" (HR) newborns (small for gestational age, large for gestational age, twin, infant of diabetic mother) with poor adherence and low yield. We aimed to decrease polycythemia screening of asymptomatic HR infants by 80% within 6 months.
Methods:
We conducted an improvement project at a tertiary children's hospital using the Model for Improvement. Eligible infants had an HR ICD-10 code on their problem list, were asymptomatic, over 35 weeks gestational age, and remained in the nursery for >6 hrs. Interventions included discontinuation of prior protocol, education for staff, bimonthly feedback on project performance, and visual reminders. Our primary outcome measure was the proportion of asymptomatic infants who received a hematocrit screen. Secondary measures were screening costs. Balancing measures were the length of stay, detected/symptomatic polycythemia, transfers to ICU/wards, and readmissions within 1 week of discharge.
Results:
The Nursery unit screened 80% of HR infants at baseline. This decreased to 7.3% after PDSA1, 0% after PDSA2, and 1% after PDSA3. There was no symptomatic polycythemia or statistically significant increase in readmissions/transfers. One month of monitoring revealed persistent changes.
Conclusion:
Simple quality improvement interventions such as education, reminders, and feedback can facilitate the deimplementation of low-value practices.
