Associate Professor of Clinical Pediatric/Pediatric Hospitalist University of Illinios College of Medicine Peoria, Illinois, United States
Background: Neonatal toxicology screens are frequently overused for newborns, particularly in cases where inadequate prenatal care (PNC) is suspected. These screens can lead to unnecessary interventions and increased stress for families. We aimed to standardize the definition of inadequate PNC and reduce unnecessary screenings. Additionally, our project aligns with the goals of Diversity, Equity, and Inclusion by ensuring that screening decisions are based on consistent, equitable criteria that minimize potential biases, especially for vulnerable populations. Objective: From August 2023 to August 2024, we aim to decrease the proportion of neonatal toxicology screens by 5% in newborns ≥36 weeks gestation through two key interventions: (1) standardizing the definition of inadequate PNC using the Kessner Index, and (2) continuing this standard while excluding isolated marijuana use in the second PDSA cycle. The baseline proportion of neonatal toxicology screens was 16%. Design/Methods: We utilized the Plan-Do-Study-Act framework. A multidisciplinary team adopted the modified Kessner Index for defining inadequate PNC. Baseline data on the proportion of toxicology screens were collected and analyzed (Figure 1). Staff education on the standardized definition was supported through a Key Driver Diagram (Figure 2). Monthly data were tracked using a statistical process control chart to monitor progress (Figure 3). Results: At baseline, 16% of newborns underwent toxicology screens. After implementing the first PDSA cycle, which standardized the definition of inadequate PNC, the proportion of neonatal toxicology screens decreased to 13%, reflecting a 3 % reduction. Following the second PDSA cycle, which excluded isolated marijuana use, the proportion of screens dropped further to 9%. We set an aim for a 5% decrease but achieved a 7% absolute reduction, which represents a 43.75% relative reduction from the baseline of 16%. Additionally, there was a significant shift of data below the central line in the control chart, indicating that the interventions had a meaningful impact. No neonatal readmissions for withdrawal symptoms were reported, confirming the safety of the intervention.
Conclusion(s): Standardizing the definition of inadequate PNC using the Kessner Index, along with excluding isolated marijuana use, led to a significant improvement in reducing neonatal toxicology screens. This intervention is expected to decrease unnecessary testing, reduce healthcare costs, and minimize the stigma associated with toxicology screening, while promoting equity and reducing bias in clinical decision-making.
