P2.N267: A Quality Improvement Initiative to Reduce Phototherapy Use in Newborn Infants Utilizing Revised AAP Neonatal Hyperbilirubinemia Guidelines in a Rural Community Hospital.

Purpose/Objectives: The primary aim was to decrease phototherapy use among newborns ≥ 35 weeks’ gestation with jaundice by at least 20% in one year.

In August 2022, the American Academy of Pediatrics (AAP) published a revised clinical guideline for management and prevention of hyperbilirubinemia in the newborn infant ≥ 35 weeks’ gestational age (GA). The new guideline incorporates hour-specific recommendations for treatment and follow-up. We implemented a quality improvement (QI) project utilizing the revised AAP guidelines to evaluate the impact on phototherapy use and readmissions.

Design/Methods: This QI project was performed at a rural community hospital with around 700 births per year. Only the newborns delivered at this hospital were included. Newborns < 35 weeks GA or those who were transferred to other facilities were excluded. Baseline data were obtained from April to August 2022. Key drivers for the project were identified (Fig 1). We developed a project specific QI committee and performed multiple interventions including Electronic Medical Records (EMR) optimization, multidisciplinary education, protocol update, and practice standardization from September 2022 to January 2023. We used Plan-Do-Study-Act (PDSA) cycle methodology to identify barriers and implement improvements using data from monthly reports. Post-intervention data were collected for 12 months from February 2023 to January 2024. The process measure was the number of newborns with jaundice, percentage of newborns with jaundice receiving phototherapy was the outcome measure, and readmissions was the balancing measure. A neonatal nurse practitioner-run bilirubin clinic was established in October 2022 to ensure consistent outpatient follow-up including weekends. Monthly data were plotted on the run charts.

Results: All newborns were tested for jaundice during the hospital stay. Data were obtained from 245 charts of newborns with diagnosis of neonatal jaundice: 59 pre-intervention, 51 during the intervention and 135 post-intervention. The average percentage of newborns with jaundice remained about the same, it was 19.4% pre-intervention and 19.7% post-intervention. The percentage of newborns with jaundice treated with phototherapy declined by 50.2% after implementation of new guidelines, 27.5% pre-intervention down to 13.7% post-intervention (Fig 2). The number of readmissions decreased from 6.8% (4 readmissions pre-intervention) to 2.4% (3 readmissions post-intervention). The average length of hospital stay (LOS) for newborns who required phototherapy was 3.1 days, while those without phototherapy treatment the LOS was 2.1 days. The decrease in LOS leads to decrease in cost of healthcare.

Conclusion/Discussion: Implementation of a QI project utilizing the revised AAP neonatal jaundice guidelines reduced phototherapy use by 50.2% in infants with jaundice without an increase in number of readmissions. Reducing phototherapy use has a potential impact of reducing LOS and hospital cost while improving infant bonding and breast feeding.