Neonatal jaundice is a common condition that can result in devastating consequences if not treated aggressively. Despite evidence‐based guidelines for monitoring and treating hyperbilirubinemia, variation in care persists that can result in suboptimal outcomes. Previous quality improvement (QI) efforts have focused only on nursery or outpatient monitoring of jaundice.
The goal of our project was to improve the care for infants admitted to the pediatric ward with unconjugated hyperbilirubinemia by using a multidisciplinary, multifaceted approach. The 2004 American Academy of Pediatrics (AAP) guidelines titled “Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation” served as our standard of care.
Our multidisciplinary working group consists of attending physicians, clinical nurses, case managers, and a medical student. For our baseline data, we reviewed all ward admissions with a principal diagnosis of hyperbilirubinemia from the first quarter of 2010 (n = 28). The average length of stay was 33 hours (range, 16–94 hours). Regarding compliance with AAP guidelines, 52% of infants received intravenous fluids (not recommended), and 43% had a rebound bilirubin checked prior to discharge (not recommended.) In addition, only 62% of infants admitted for breastfeeding jaundice had a lactation consult during their admission. Using this baseline data and the Model for Improvement, we developed specific aims, measures, and rapidcycle interventions for our project. We have defined the following goals to be accomplished by June 30, 2011: decrease average length of stay to <30 hours and improve compliance with AAP guidelines to >90%. As a balancing measure, we will monitor family satisfaction, including readiness for discharge. To inform our educational interventions, we have created a needs assessment for pediatric residents and clinical nurses that evaluate both knowledge and comfort with management of infants with jaundice. In addition, we have developed an institutional guideline that has been agreed on by our hospitalist group to streamline the workup and management, as well as serve as a foundation for educating trainees. Future efforts will focus on creating a standardized order set to be used during the admission process. Data on length of stay and compliance with AAP guidelines as well as family satisfaction will be obtained on a monthly basis through ongoing chart reviews and Press Ganey surveys.
A multidisciplinary approach is crucial to the success of any quality improvement project, and hospitalists are natural leaders for inpatient QI projects. Through needs assessments, brief educational interventions, and a collaborative management guideline, we hope to significantly improve the care we provide to infants admitted with hyperbilirubinemia.
K. Tartaglia ‐ none; K. Krivchenia ‐ none
To cite this abstract:Tartaglia K, Krivchenia K. Multifaceted Approach to Improving the Inpatient Management of Infants with Hyperbilirubinemia. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 214. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/multifaceted-approach-to-improving-the-inpatient-management-of-infants-with-hyperbilirubinemia/. Accessed May 24, 2019.