WIP 77 - Improving Hemoglobin Monitoring in Hospitalized Infants Undergoing Phototherapy for Indirect Hyperbilirubinemia: A Quality Improvement Initiative

Publication Number: WIP 77.7504

Madhuri Prasad, Emory University School of Medicine, Atlanta, GA, United States; Vedant Gupta, Children's Healthcare of Atlanta, Dunwoody, GA, United States; Neema Shah, Emory University School of Medicine, Atlanta, GA, United States

Background: Indirect hyperbilirubinemia is a common condition in neonates. The American Academy of Pediatrics (AAP) updated its clinical practice guidelines (CPG) in 2022, emphasizing the importance of managing indirect hyperbilirubinemia to minimize the risk of kernicterus, a severe, irreversible neurologic condition. For infants requiring phototherapy, the AAP guidelines recommend measuring the hemoglobin and/or hematocrit concentrations to detect anemia, if present, and to obtain a baseline for any subsequent anemia, providing valuable information about any underlying hemolytic diseases. Currently at our tertiary care center, there is a variation in care for monitoring hemoglobin and/or hematocrit measurements in infants admitted to the pediatric hospital medicine service for phototherapy. Though a quality improvement (QI) initiative, we aim to minimize this variation in care by utilizing new local hyperbilirubinemia CPG that were implemented in the fall of 2024.

Objective: For infants (≤ 14 days and ≥ 35 weeks gestation) admitted to the pediatric hospital medicine service for phototherapy treatment of indirect hyperbilirubinemia, our goal is to improve the percentage of patients with hemoglobin and/or hematocrit measurements from 61% to 75% by March 7th, 2025.

Design/Methods: A multi-disciplinary task group, including pediatric hospitalists, neonatologists, and pediatric emergency department (ED) physicians, was organized to develop an ED and inpatient hyperbilirubinemia CPG and electronic medical record (EMR) order-set. Additional interventions include provider education via division meetings, flyers, and emails. We will obtain and review data monthly from the EMR and manually chart review to develop run charts. Our primary outcome measure is the percentage of patients with hemoglobin and/or hematocrit measurements. One of the secondary outcome measures is the percentage of patients with anemia present. One of the balancing measures is the 7-day readmission rate. Our institutional review board submission is currently pending as data collection will involve manual chart review.