title: Implementation of the Canadian Paediatric Society's hyperbilirubinemia guidelines: A survey of Ontario hospitals.
abstract: BACKGROUND
  In 2007, the Canadian Paediatric Society (CPS) published guidelines aimed at preventing severe hyperbilirubinemia.
  
  
  OBJECTIVE
  To determine whether hospitals had implemented these guidelines; to investigate how guideline-recommended care is organized; and to understand the factors influencing guideline implementation.
  
  
  METHODS
  The present study was an online survey conducted from December 2011 to May 2012 of all Ontario hospitals offering maternal-newborn services.
  
  
  RESULTS
  A total of 97 of 100 eligible hospitals responded. Seventy-seven of the 97 (79%) respondents reported having implemented universal neonatal bilirubin screening. Among these hospitals, hospital-based postdischarge follow-up was reported more frequently than follow-up at community-based locations: hospital laboratory (n=40 [52%]), mother-baby care unit (n=32 [42%]), outpatient clinic (n=25 [33%]), primary care provider in community (n=19 [25%]) and community laboratory (n=8 [10%]). The CPS guidelines were the most frequently reported factor influencing implementation (n=74 [96%]).
  
  
  CONCLUSIONS
  The survey provides valuable insight into the impact of a complex guideline in Canada's largest province. There was heterogeneity in how hospitals organized services, but there was a notable trend toward hospital-based postdischarge care. The shift to hospital-based care runs counter to current health policy directions and highlights the lack of integration among health care sectors.
  
  
  CONCLUSIONS
  The majority of Ontario hospitals implemented universal bilirubin screening following the release of the CPS guidelines. Further analysis is needed to determine the impact that the guidelines and the differences in implementation have had on clinical outcomes and the utilization of health services.
authors.affiliation: Population Health Program, University of Ottawa; ; Midwifery Education Program, Laurentian University;
authors.forename: Elizabeth Kathleen
authors.initials: EK
authors.lastname: Darling
authors.affiliation: Institute for Clinical Evaluative Sciences, University of Toronto, Toronto; ; Division of Paediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto; ; Department of Paediatrics and Institute of Health Policy and Management and Evaluation, University of Toronto, Toronto;
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
authors.affiliation: Better Outcomes Registry & Network (BORN) Ontario;
authors.forename: Ann E
authors.initials: AE
authors.lastname: Sprague
authors.affiliation: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario; ; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario;
authors.forename: Timothy
authors.initials: T
authors.lastname: Ramsay
authors.affiliation: Better Outcomes Registry & Network (BORN) Ontario; ; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario; ; Department of Obstetrics & Gynecology, University of Ottawa, Ottawa, Ontario.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Walker
keywords: Guideline adherence; Hyperbilirubinemia; Jaundice; Practice guideline