P2.N272: Decreasing Frequency of Bilirubin Testing in Newborns Admitted for Hyperbilirubinemia: a Quality Improvement Study.

Purpose/Objectives: Obtaining blood for laboratory testing in pediatric patients is a known source of distress for patients and their parents. For patients with hyperbilirubinemia admitted to our pediatric hospital medicine service, serial bilirubin testing was obtained every 6 hours and on average, patients had their bilirubin level checked ~5 times during an admission. In response to updated clinical guidelines for hyperbilirubinemia published by the AAP in 2022, we developed a clinical pathway for patients with hyperbilirubinemia admitted to our pediatric hospital medicine (PHM) service and utilized implementation of this pathway to decrease frequency of bilirubin testing.

Design/Methods: Using quality improvement methodology, we implemented the newly developed hyperbilirubinemia clinical pathway. Our interventions included multiple resident education sessions, e-mail reminders to residents rotating on the PHM service, a dedicated hyperbilirubinemia history and physical template, and the pathway was integrated into AgileMD, an EHR tool that allows easy access to clinical guidelines. In addition to monitoring frequency of bilirubin testing, we monitored length of stay, frequency of rebound bilirubin testing, IV fluid usage, readmissions, and NICU transfers in patients with hyperbilirubinemia from September 2021 to January 2024.

Results: Prior to implementation of the pathway, patients admitted with hyperbilirubinemia were subject to 4.9 blood draws per admission and following our intervention, there was a decrease to 4.18 with a center line shift without any increase in our balancing measures (NICU transfers, readmissions) (Figure 1). There was a decrease in average length of stay from 26.1 hours to 24.0 hours, number of patients receiving IV fluids from 35.8% to 25.4%, number of patients readmitted after discharge from 4.7% to 0%, and number of patients requiring NICU transfer from 0.9% to 0%. There was an increase in rebound bilirubin testing following discontinuation of phototherapy from 56.9% to 67.8%.

Conclusion/Discussion: Effective implementation of a hyperbilirubinemia clinical pathway using QI methodology demonstrated we were able to safely decrease the number of bilirubin testing in patients with hyperbilirubinemia admitted to our PHM service without an increase in our balancing measures.