Attending Physician Rush University Medical Center CHICAGO, Illinois, United States
Background: In 2022, the American Academy of Pediatrics (AAP) released new clinical practice guidelines for the treatment of neonatal hyperbilirubinemia for the first time since 2004. [1] These guidelines changed the thresholds for starting phototherapy in neonatal hyperbilirubinemia and did away with the risk curves delineated by the Bhutani nomograms. [1,2] This significant shift in clinical management of neonatal hyperbilirubinemia, spurred our institution’s quality improvement initiative to comply with the new clinical guidelines as a part of the AAP national quality improvement collaborative. We focused heavily on electronic medical record-based tools for the serial interventions used in this project. Given the near universal presence of electronic medical records across the United States, this represents a valuable resource for institutions in the implementation of quality improvement initiatives. [3] Objective: We aimed to decrease the rate of subthreshold initiation of phototherapy in full-term neonates to 10% over 12 months through electronic medical record-based interventions. Design/Methods: At our urban, imbedded children’s hospital; we constructed a multidisciplinary team of general pediatricians, pediatric hospitalists, neonatologists, and pediatric resident physicians across all divisions that care for neonates with hyperbilirubinemia. In this group, we devised a clinical pathway, an order set, note templates, and phototherapy curves based on the 2022 AAP hyperbilirubinemia clinical practice guidelines. The primary outcome was the monthly rate of subthreshold phototherapy. Results: 238 patient encounters were included in our baseline period from February 2022 to January 2023. This period spanned 6 months before and after the release of the 2022 guidelines. 177 patient encounters were included in the intervention period from February 2023 to January 2024. For the primary outcome of decreasing the monthly rate of subthreshold phototherapy, there was a centerline shift noted in July 2023. Across all divisions, the monthly rate of subthreshold phototherapy decreased from 48.3% to 33%. The rate of hyperbilirubinemia greater than 25 mg/dL and readmission were unchanged.
Conclusion(s): Our quality improvement initiative demonstrated the effectiveness of an electronic medical record-based tool kit in reducing the rate of subthreshold phototherapy.
Subthreshold Phototherapy P Chart PAS P chart 12 months--annotated.pdfThe monthly rate of subthreshold phototherapy decreased from 48.3% to 33%.
