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Comparing Outcomes Between Direct and ED Admissions for Neonatal Hyperbilirubinemia
Ashleigh Slemmer1, Brett Klamer2, Christine Schmerge1
1Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Direct admission for neonatal hyperbilirubinemia reduces emergency department visits and improves care efficiency. This approach offers shorter hospital stays and less resource use without impacting readmission rates for phototherapy.
Area of Science:
- Pediatrics
- Neonatology
- Healthcare Management
Background:
- Pediatric direct admissions (DA) offer benefits like reduced emergency department (ED) volumes and improved patient satisfaction.
- Neonatal hyperbilirubinemia is a common reason for pediatric admissions.
Purpose of the Study:
- To compare resource utilization and patient outcomes between direct admissions and ED admissions for neonatal hyperbilirubinemia.
Main Methods:
- A retrospective study analyzed 1098 patients with neonatal hyperbilirubinemia admitted between 2017-2021.
- Compared outcomes including length of stay, time to care, resource use, NICU transfer, and 7-day readmissions for direct admissions versus ED admissions.
Main Results:
- Direct admissions (74.9%) showed shorter time to bilirubin collection and phototherapy initiation.
- Directly admitted patients received less IV fluids and had fewer bilirubin tests.
- Length of stay was shorter for direct admissions (21 vs 23 hours), with no significant difference in 7-day readmissions for phototherapy.
Conclusions:
- Direct admission for neonatal hyperbilirubinemia is preferable to ED admission.
- This pathway leads to faster clinical care, shorter hospital stays, and reduced resource utilization.
- Patient safety and readmission rates for phototherapy remain comparable between admission methods.
Objectives:
Pediatric direct admissions (DA) have multiple benefits including reduced emergency department (ED) volumes, greater patient and provider satisfaction, and decreased costs without compromising patient safety. We sought to compare resource utilization and outcomes between patients with a primary diagnosis of neonatal hyperbilirubinemia directly admitted with those admitted from the ED.
Methods:
Single-center, retrospective study at a large, academic, free-standing children's hospital (2017-2021). Patients were between 24 hours and 14 days old with a gestational age of ≥35 weeks, admitted with a primary diagnosis of neonatal hyperbilirubinemia. Outcomes included length of stay (LOS), time to clinical care, resource utilization, NICU transfer, and 7-day readmission for phototherapy.
Results:
A total of 1098 patients were included, with 276 (25.1%) ED admissions and 822 (74.9%) DAs. DAs experienced a shorter median time to bilirubin level collection (1.9 vs 2.1 hours, P = .003), received less intravenous fluids (8.9% vs 51.4%, P < .001), had less bilirubin levels collected (median of 3.0 vs 4.0, P < .001), received phototherapy sooner (median of 0.8 vs 4.2 hours, P < .001), and had a shorter LOS (median of 21 vs 23 hours, P = .002). One patient who was directly admitted required transfer to the NICU. No differences were observed in the 7-day readmission rates for phototherapy.
Conclusions:
Directly admitting patients for the management of neonatal hyperbilirubinemia is a preferred alternative to ED admission as our study demonstrated that DAs had a shorter time to clinical care, shorter LOS, and less unnecessary resource utilization with no difference in 7-day readmissions for phototherapy.
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