130 - A health system intervention to decrease readmissions for newborn hyperbilirubinemia

Poster Number: 130
Publication Number: 130.1403

Background: The 2022 American Academy of Pediatrics (AAP) Clinical Practice Guideline (CPG) revision for newborn hyperbilirubinemia made significant changes, including higher thresholds for phototherapy initiation.

Objective: Our global aim was to align newborn care across a health system with the new CPG. Our specific aim was to decrease number of readmissions for phototherapy by 20% in 12 months.

Design/Methods: Using the model for improvement, a stakeholder team of pediatric, neonatal, and newborn care physicians and nurses gathered to conduct this quality improvement (QI) initiative at two hospitals within our health system: our state’s largest birthing hospital and nearby affiliated tertiary care academic pediatric hospital. Baseline data was collected February to August 2022 and implementation data September 2022 to September 2023. Otherwise healthy infants less than or equal to 14-days-old readmitted to the pediatric hospital general ward for hyperbilirubinemia were included. Data collection occurred by retrospective chart review, including demographics of gender, race and gestational age, as part of the AAP Learning and Implementing Guidelines for Hyperbilirubinemia Treatment project. Primary outcome measure was number of monthly admissions to the general pediatric ward, analyzed using a run chart. An additional outcome measure was time between initiation of subthreshold phototherapy, defined as starting greater than or equal to 0.3 mg/dL below threshold, tracked on an SPC t-chart. Balancing measure of length of stay (LOS) was analyzed on an XbarS chart. Interventions included provider education sessions, clinical guideline updates, revised note templates, and electronic health record updates with creation of an actionable workflow pathway and link to BiliTool.

Results: A total of 8,222 deliveries occurred at the birthing hospital during the study period, with 93 readmissions for hyperbilirubinemia (readmission rate 1.1%). Readmitted patients were 65% male and 71% white; average gestational age was 38 weeks. Median number of readmissions per month decreased by 67% from baseline to implementation period, from 6 to 2 (Figure 1a). Mean days between subthreshold phototherapy was 14.8 (Figure 1b). Average LOS was 20.8 hours, with greater variation during implementation phase (Figure 1c).

Conclusion(s): This health system QI initiative significantly decreased newborn readmissions for inpatient phototherapy, which benefits not only to the patient and family, but also the healthcare system. Future focus on decreasing admission at subthreshold phototherapy levels may lead to further reductions in readmissions.