Improving Quality of Care for Neonatal Hyperbilirubinemia Admissions After Birth Hospitalization.

Abstract

Background and objectives: Infants with neonatal hyperbilirubinemia (NH) often require admission after their birth hospitalization for treatment with phototherapy. Our aim was to align local practice with updated national guidelines to promote efficiency and decrease length of stay (LOS) for this patient population by ∼ 10% over a 15-month period using quality improvement methodology.

Methods: Our improvement initiative included infants younger than age 14 days born at more than 35 weeks' gestation admitted to the hospital medicine service with an NH diagnosis. Baseline data were collected from November 2021 to December 2022. A current state analysis highlighted targets for interventions. Interventions included aligning the local practice pathway with 2022 American Academy of Pediatrics guidelines for NH, adding additional phototherapy lights, and leveraging the electronic health record to improve inter-provider communication over 3 Plan-Do-Study-Act (PDSA) cycles between January 2023 and March 2024. Statistical process control was used for analysis.

Results: There were 130 patients included during the 15-month intervention period. After 3 PDSA cycles, there was no special cause variation in the primary outcome measure, LOS. There was special cause variation in the primary process measure, total serum bilirubin at discharge. Readmissions for phototherapy, tracked as a balancing measure, did not change during the study period.

Conclusions: Successive interventions aimed at optimizing efficiency during NH admissions did not result in decreased LOS. It can be challenging to use LOS as an outcome measure given the influence of various systemic factors that may not be controlled or reasonably changed.