A Partner Hospital Intervention to Decrease Readmissions for Newborn Hyperbilirubinemia

Abstract

Introduction: The 2022 American Academy of Pediatrics Clinical Practice Guideline revision for newborn hyperbilirubinemia raised thresholds for phototherapy initiation. Our global aim was to align care across 2 partner hospitals with the revised clinical practice guideline. Our aim was to decrease readmissions for phototherapy by 20% in 12 months.

Methods: Using the model for improvement, a stakeholder team conducted this quality improvement initiative at our state's largest birthing hospital and partner pediatric hospital. We collected baseline data from January to August 2022 and implementation data from September 2022 to February 2024. We included newborns 14 days or younger readmitted to the pediatric hospital general ward for phototherapy. Interventions included provider education, local clinical guidelines, and electronic medical record updates. Outcome measures of count and rate of monthly readmissions were tracked on a C chart and U chart, respectively. The process measure of time between occurrence of subthreshold phototherapy initiation was tracked on a t-chart. The balancing measure of the length of stay was analyzed on an XbarS chart. We assessed special cause variation using established statistical process control chart rules.

Results: A total of 10,620 deliveries occurred, with 104 readmissions for hyperbilirubinemia. The mean count of monthly readmissions decreased from 5.8 to 2.4 from the baseline to the implementation period; the rate of monthly readmissions decreased from 1.4% to 0.6%. Mean days between the occurrence of subthreshold phototherapy initiation increased from 15.5 to 62.5 days. The average length of stay remained at 21.5 hours.

Conclusions: This partner hospital initiative significantly decreased newborn hyperbilirubinemia readmissions.

Fig. 1.

Key driver diagram demonstrating global aim, primary and secondary drivers, and change ideas to achieve the aim.

Fig. 2.

Count and rate of hyperbilirubinemia readmissions. A, SPC C chart of count of monthly hyperbilirubinemia readmissions to pediatric hospital with annotated interventions at birthing and nonbirthing pediatric hospital. The mean number of readmissions decreased from 5.8 to 2.4 patients per month. B, SPC U chart of rate of monthly hyperbilirubinemia readmissions to pediatric hospital with annotated interventions. The rate of readmissions decreased from 1.4% to 0.6% per month. UCL, upper control limit.

Fig. 3.

SPC t-chart of days between the occurrence of subthreshold phototherapy initiation at a pediatric hospital, defined as initiating phototherapy at ≥0.3 mg/dL below the AAP threshold. The mean days between the occurrence of subthreshold phototherapy initiation increased from 15.5 to 62.5 days. UCL, upper control limit.

Fig. 4.

Length of stay. A, Xbar chart of the average length of stay in hours at pediatric hospital for hyperbilirubinemia readmissions. B, S chart. LCL, lower control limit; UCL, upper control limit.