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Improving Quality of Care for Neonatal Hyperbilirubinemia Admissions After Birth Hospitalization
Danielle Owerko1, Kelsey Ryan1, Sarah Corey Bauer1
1Medical College of Wisconsin, Milwaukee, Wisconsin.
Insights
Quality improvement efforts to reduce hospital length of stay for infants with neonatal hyperbilirubinemia (NH) did not decrease LOS. Total serum bilirubin at discharge showed improvement, but LOS remained unchanged due to systemic factors.
Area of Science:
- Pediatrics
- Neonatology
- Quality Improvement Science
Background:
- Neonatal hyperbilirubinemia (NH) frequently necessitates hospital admission for phototherapy post-birth hospitalization.
- Current practices often require lengthy stays, impacting healthcare efficiency.
Purpose of the Study:
- To align local NH treatment protocols with 2022 American Academy of Pediatrics guidelines.
- To decrease the length of stay (LOS) for infants with NH by approximately 10% over 15 months.
- To enhance efficiency in managing NH admissions through quality improvement methods.
Main Methods:
- A quality improvement initiative involving infants under 14 days with NH, born >35 weeks gestation.
- Implementation of updated clinical pathways, additional phototherapy lights, and enhanced electronic health record communication.
- Utilized 3 Plan-Do-Study-Act (PDSA) cycles and statistical process control for analysis over a 15-month period.
Main Results:
- No significant reduction in the primary outcome, length of stay (LOS), was observed after interventions.
- A statistically significant improvement was noted in the process measure of total serum bilirubin levels at discharge.
- Readmission rates for phototherapy remained unchanged, indicating no adverse impact.
Conclusions:
- Interventions to optimize efficiency in NH admissions did not lead to a decrease in LOS.
- Length of stay (LOS) is a complex outcome measure influenced by systemic factors beyond direct intervention control.
- Further research may be needed to identify more effective strategies for reducing LOS in NH patients.
Background And Objectives:
Infants with neonatal hyperbilirubinemia (NH) often require admission after their birth hospitalization for treatment with phototherapy. Our aim was to align local practice with updated national guidelines to promote efficiency and decrease length of stay (LOS) for this patient population by ∼ 10% over a 15-month period using quality improvement methodology.
Methods:
Our improvement initiative included infants younger than age 14 days born at more than 35 weeks' gestation admitted to the hospital medicine service with an NH diagnosis. Baseline data were collected from November 2021 to December 2022. A current state analysis highlighted targets for interventions. Interventions included aligning the local practice pathway with 2022 American Academy of Pediatrics guidelines for NH, adding additional phototherapy lights, and leveraging the electronic health record to improve inter-provider communication over 3 Plan-Do-Study-Act (PDSA) cycles between January 2023 and March 2024. Statistical process control was used for analysis.
Results:
There were 130 patients included during the 15-month intervention period. After 3 PDSA cycles, there was no special cause variation in the primary outcome measure, LOS. There was special cause variation in the primary process measure, total serum bilirubin at discharge. Readmissions for phototherapy, tracked as a balancing measure, did not change during the study period.
Conclusions:
Successive interventions aimed at optimizing efficiency during NH admissions did not result in decreased LOS. It can be challenging to use LOS as an outcome measure given the influence of various systemic factors that may not be controlled or reasonably changed.
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