Timely Screening for Hyperbilirubinemia in Late Preterm Infants

Timely Screening for Hyperbilirubinemia in Late Preterm Infants Background and Rationale: Late preterm (LPT) infants are at an increased risk for hyperbilirubinemia. At a local hospital, the protocol required LPT bilirubin levels drawn at 24 hours of life (HOL). Stakeholders reported rarely treating LPT infants at 24 HOL. Rather, pre-discharge bilirubin levels (at ~ 48 HOL) would indicate treatment, often leading to increased length of stay (LOS). Purpose: The purpose of this quality improvement initiative was to more accurately identify hyperbilirubinemia in LPT infants. A new protocol was developed and implemented, ordering TSBs drawn at 36 HOL based on the evidence that a natural rise in bilirubin begins after 24 HOL. This project evaluated the effectiveness of that initiative. Methodology: Evaluation of the protocol via retrospective electronic medical records review, divided into three cohorts. Data were analyzed using descriptive statistics and chi-square for dichotomous data. Outcome Measures: Staff compliance, hospital LOS, phototherapy rates, readmissions for hyperbilirubinemia, and blood draw rates. Results: Statistically significant improvement in compliance when comparing Cohort A to B (p = 0.05), Cohort A to C (p = 0.05), and Cohort A to B plus C (p < 0.001). No statistically significant improvement when comparing Cohort B to C (p = 0.43). No statistically significant improvement in hospital LOS among any of the cohorts. There was no increased LOS among the cohorts. Readmissions were down to zero in Cohort C. More infants were identified and treated with phototherapy as evidenced by an increase from 17.7 percent in Cohort A to 29.7 percent and 34.9 percent in Cohorts B and C. Blood draw rates declined steadily, down from 1.9 per infant in Cohort A to 1.3 per infant in Cohort C. Conclusions: Staff compliance was relatively low in Cohorts B and C, making it difficult to determine the full effects of the policy change on LOS. As a result of the protocol change, more infants were identified and treated without increased LOS. Hospital readmission rates dropped to zero and blood draw rates decreased across cohorts. Improved staff compliance may yield greater effects of the protocol change.Doctor of Nursing Practic