Reducing Serum Bilirubin Measurements in a Newborn Nursery Using Quality Improvement Methodology

Transcutaneous bilirubin (TcB) screening in the newborn nursery (NBN) is noninvasive and appropriate for most infants; however, reported rates of total serum bilirubin (TSB) measurement remain at 17% to 30%.

From January to December 2024, 17.2% of infants solely admitted to our NBN received any TSB test, but only 45.3% of TSB measurements were concordant with the American Academy of Pediatrics guidelines. Our aim was to decrease the percentage of infants receiving any TSB measurement from 17% to 12% within 6 months by increasing the percentage of guideline-concordant TSB measurements from 45% to 75%.

Interventions included the following: (1) updated nursing protocol for bilirubin screening, (2) NBN physician manual chart review, (3) nursing education sessions, (4) NBN physician meeting to discuss ongoing barriers and potential practice changes, and (5) ongoing reinforcement of TSB indications. The outcome measure was the percentage of infants receiving any TSB test. Process measures included percentage of guideline-concordant TSB tests and TSB tests without a preceding TcB screen (unless on/post phototherapy). Balancing measures included readmissions for phototherapy and escalation of care on readmission. Data were analyzed using statistical process control.

The percentage of infants receiving any TSB test decreased from 17.2% to 11.2%. The percentage of guideline-concordant TSB tests increased from 45.3% to 85.1%, and TSB tests without a TcB screen decreased from 24.4% to 7.1%. There was no significant change in readmission rate.

Using quality improvement methodology to increase guideline-concordant TSB tests decreased the percentage of infants receiving any TSB test. This outcome is beneficial for patient-centered care, with decreased painful procedures, and for resource use.