A systems approach for neonatal hyperbilirubinemia in term and near-term newborns.
OBJECTIVE
To propose and implement a family-centered systems approach to manage newborn jaundice for safer outcomes.


METHODS
Observational study for known adverse outcomes.


METHODS
Semiprivate urban birthing hospital.


METHODS
31,059 well babies discharged as healthy from a cohort of 41,961 live births (1990-2000).


METHODS
Incremental implementation of a systems approach that incorporated a hospital policy to (a) authorize nurses to obtain a bilirubin (total serum/transcutaneous) measurement for clinical jaundice, (b) universal predischarge total serum bilirubin (at routine metabolic screening), and (c) targeted follow-up, using the bilirubin nomogram (hour-specific, percentile-based total serum bilirubin/transcutaneous bilirubin).


METHODS
Known adverse outcomes assessed for early- and late-onset severe hyperbilirubinemia before, during, and after systems approach implementation.


RESULTS
Adverse outcomes decreased for well babies: exchange transfusion, intensive phototherapy, and readmission. During the study period, there were no "never events" (total serum bilirubin greater than or equal to 30 mg/dl), while "close calls" (total serum bilirubin greater than or equal to 25 mg/dl) were 1 in 15,000 as compared to a reported incidence of 1 in 625.


CONCLUSIONS
Reduced adverse events, significant reduction in close calls, and no never events met family expectations for safer experiences with this approach.
Bhutani
Vinod K
VK
School of Medicine at Stanford University, Stanford, California, and Newborn Pediatrics, Pennsylvania Hospital, Philadelphia 19107, USA.
Johnson
Lois H
LH
Schwoebel
Ann
A
Gennaro
Susan
S
D000359:Aftercare; D000465:Algorithms; D001663:Bilirubin / Q000097:blood; D001942:Breast Feeding; D019091:Critical Pathways / Q000458:organization & administration*; D003663:Decision Trees; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis / Q000628:therapy; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000628:therapy; D017283:Neonatal Nursing / Q000458:organization & administration*; D015997:Neonatal Screening; D024802:Nurse's Role; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care; D010290:Parents / Q000193:education / Q000523:psychology; D010351:Patient Discharge; D010359:Patient Readmission; D018802:Patient-Centered Care / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D017009:Professional Autonomy; D013597:Systems Analysis
D001663:Bilirubin