706 - Standardizing the Management of Neonatal Hyperbilirubinemia

Poster Number: 706
Publication Number: 706.153

Taylor Allen, Levine Children's Hospital, Charlotte, NC, United States; Ashley Carr, Levine Children's Hospital, Charlotte, NC, United States; Rishi Laroia, Levine Children’s Hospital at Atrium Health, Charlotte, NC, United States; Melissa Schutt, Levine Children's Hospital, Charlotte, NC, United States

Background: Hyperbilirubinemia affects up to 80% of neonates and is the leading cause of hospitalization in the first week of life. Despite the 2004 AAP hyperbilirubinemia guidelines, there was significant variability in provider practice at an urban, tertiary care nursery. Utilizing an evidence-based protocol would offer the potential benefits of standardizing practice and reducing cost, inadvertent harm, and length of stay.

Objective: To standardize the neonatal management of hyperbilirubinemia in >80% of nursery infants born at ≥ 35 weeks.  

Design/Methods: We used Model for Improvement methodology and rapid cycle PDSAs under the guidance of a multidisciplinary steering committee. A team comprised of inpatient and outpatient physicians, nursing staff and quality coaches was assembled to review existing guidelines and create an evidence-based protocol. Phase 1 (start 1/2021) focused on standardizing initiation of phototherapy through an evidence-based protocol, staff education, and chart audits with provider feedback. Collected data included percentage of protocol compliance, length of stay and readmissions. Phase 2 (start 6/2021) standardized phototherapy discontinuation using a clinical decision-making tool (BiliRebound©), which helped calculate the probability of an infant having rebound hyperbilirubinemia following phototherapy discontinuation. The protocol defined a rebound risk of ≤ 10% as acceptable, therefore infants were continued on phototherapy until this threshold was achieved. Rebound serum bilirubin levels were no longer necessary. Average number of serum bilirubin draws per patient was an additional metric for phase 2.

Results: Ninety-one and ninety-three percent protocol compliance was achieved for phases 1 and 2 respectively (Figs 1&2). There was a decrease in average bilirubin draws per patient from 5.20 to 4.58. There was no change in length of stay or readmissions.

Conclusion(s): Creating an evidence-based protocol with cycles of provider education and feedback reached level two reliability, above the goal of 80%. Standardizing discontinuation of phototherapy decreased the number of serum bilirubin draws, representing a cost savings of $4800 and a reduction of overall harm to newborns with hyperbilirubinemia. We hope to use this project’s framework to transition to the newly released 2022 AAP guidelines and implement further PDSAs to reduce length of stay in this population.