Implementation of a Neonatal Hyperbilirubinemia Clinical Pathway in a Pediatric Emergency Department.

IF 1.2 Q3 PEDIATRICS Pediatric quality & safety Pub Date : 2024-11-20 eCollection Date: 2024-11-01 DOI:10.1097/pq9.0000000000000774

Collin R Miller, Catherine Haut, Arezoo Zomorrodi, Karina Chara, Janice Wilson

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Abstract

Background: High volumes and competing priorities delay care initiation for neonatal hyperbilirubinemia within the pediatric emergency department (ED). Our freestanding children's hospital developed a quality improvement project to implement a nurse-initiated neonatal hyperbilirubinemia clinical pathway (CP) intended to decrease treatment initiation and intravenous fluid (IVF) rates.

Methods: A multidisciplinary team used the model for improvement to delineate and address key drivers of treatment delays. The team established a nurse-driven CP and enhanced the electronic health record to support and enforce new workflows, which included capillary specimen collection and phototherapy initiation before the first provider assessment. IVF criteria and laboratory evaluation were standardized. The primary aim was to decrease the time to initiation of phototherapy from a mean of 136 to 60 minutes after ED arrival for 6 months. The secondary aim was to decrease the proportion of patients obtaining IVF from 31% to 15% for the same time frame.

Results: ED arrival to phototherapy initiation decreased from 136 to 49 minutes. The IVF rate decreased from 31% to 12%. ED length of stay decreased from 185 to 122 minutes. Hospital length of stay remained unchanged.

Conclusions: A nurse-initiated CP for neonates with hyperbilirubinemia improved time-to-care initiation and ED throughput while decreasing unnecessary IVF administration.

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在儿科急诊室实施新生儿高胆红素血症临床路径。

背景：在儿科急诊室（ED）中，高流量和优先级竞争会延误新生儿高胆红素血症的治疗。我们的独立儿童医院开展了一项质量改进项目，实施由护士发起的新生儿高胆红素血症临床路径（CP），旨在降低治疗启动率和静脉输液（IVF）率：方法：一个多学科团队利用改进模型来确定并解决治疗延误的关键因素。该团队建立了以护士为主导的 CP，并增强了电子病历以支持和执行新的工作流程，其中包括在首次提供者评估之前收集毛细血管标本和启动光疗。试管婴儿标准和实验室评估均已标准化。主要目标是在 6 个月内将启动光疗的平均时间从到达急诊室后的 136 分钟缩短至 60 分钟。次要目标是将同期获得体外受精的患者比例从 31% 降至 15%：结果：从到达急诊室到开始光疗的时间从 136 分钟缩短至 49 分钟。体外受精率从 31% 降至 12%。急诊室停留时间从 185 分钟缩短至 122 分钟。住院时间保持不变：由护士发起的新生儿高胆红素血症光疗改善了护理启动时间和急诊室吞吐量，同时减少了不必要的静脉输液。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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