Quality Improvement Reduces Excessive Serum Bilirubin Laboratory Draws in a Community Hospital Nursery

Newborn jaundice is common and requires appropriate monitoring and treatment to prevent acute bilirubin encephalopathy and kernicterus. Minimizing total serum bilirubin (TsB) draws has many benefits, including decreasing blood loss and painful procedures, as well as saving time and costs.

The objective of this study was to test an iterative quality improvement process to reduce the percentage of newborns receiving TsB draws by half, ie, from 30.6% to 15.3%, at a community hospital nursery over 18 months.

Baseline data were collected retrospectively, and intervention period data were collected prospectively. Root cause analysis revealed a lack of consensus for when a TsB draw is needed. Interventions included the following: (1) dissemination of 2022 American Academy of Pediatrics hyperbilirubinemia guidelines, (2) physician journal club and consensus on practice changes, (3) monthly team meetings to review data and troubleshoot barriers, (4) use of the BiliTool calculator, and (5) nursing education. The primary outcome was percentage of newborns who had a TsB draw. Secondary outcomes were percentage of newborns requiring phototherapy, average length of stay, and average number of TsB draws per newborn who had a TsB draws. The balancing measure was the 7-day readmission rate. Outcome measures were analyzed using statistical process control.

The percentage of newborns receiving a TsB draw declined from 30.6% to 17.3%. The percentage of newborns receiving phototherapy decreased from 7.6% to 5.2%. Average length of stay, average number of TsB draws per patient who had a TsB draw, and readmission rate remained unchanged.

An iterative quality improvement process effectively decreases unnecessary newborn TsB draws. This process may be used by other community hospitals to affect change in their nurseries.