171 - Implementing New Clinical Practice Guidelines for Management of Hyperbilirubinemia in Newborn Infants
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 171 Publication Number: 171.331
Christine SanGiovanni, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Erin Balog, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Michelle Amaya, Medical University of South Carolina College of Medicine, Charleston, SC, United States
Associate Professor Medical University of South Carolina College of Medicine Charleston, South Carolina, United States
Background: The AAP has recently published new guidelines on the management of newborn hyperbilirubinemia. We have implemented and disseminated the new guidelines to all pediatric trainees at our institution. Objective: To design and deliver an educational curriculum, assess for knowledge and skill acquisition, and plan for ongoing quality improvement incorporating this new clinical practice guideline on management of newborn hyperbilirubinemia across our pediatric department. Design/Methods: We created a one-hour workshop for pediatric residents using graphs and tables published in the guidelines to discuss three cases that address many key action statements in the new guidelines. Residents evaluated the workshop with an 8-question retrospective pre and post-assessment. A two-tailed T test was performed to analyze responses for each aspect of assessment and management pre and post-intervention. In addition to resident education, we are educating clinical staff, creating updated protocols for use in the newborn nursery, and creating pathways for use across divisions that will be incorporated into the Electronic Health Record for use in the clinic, inpatient units, and Emergency Department. Results: Thirty-three residents completed a retrospective pre and post-assessment rating their knowledge and management skills of newborn hyperbilirubinemia. Residents’ reported knowledge on identifying risk factors for hyperbilirubinemia (P< 0.01), identifying neurotoxic risk factors (P< 0.01), determining when to draw a serum bilirubin (P< 0.01), using new graphs/tables (P < 0.01), calculating rate of rise of bilirubin (P< 0.01), when to stop phototherapy (P< 0.01), when to follow up after phototherapy (P< 0.01), and using the value of delta total serum bilirubin for determining discharge of newborn (P< 0.01) were all statistically significant. Although there was improvement in resident knowledge on all assessment questions, residents voiced uncertainty regarding when a patient had neurotoxic risk factors and when to stop phototherapy in a newborn.
Conclusion(s): Creating clinical cases to discuss the key action statements for hyperbilirubinemia management helped improve resident knowledge on the new guidelines. We are working to expand on this educational intervention to help all hospital staff and community providers use the new guidelines. In addition to delivering educational interventions, we are designing flowcharts across divisions to improve utility and adoption across clinical settings. Over the next year, we will evaluate barriers to implementation and design interventions to improve adherence.