Michelle Long1,2, Ken J Farion2,3, Roger Zemek2,3, Debby Voskamp2, Nick Barrowman1,4, Salwa Akiki4, Sarah Reid2,3. 1. Department of Pediatrics, University of Ottawa, Ottawa, Ontario. 2. Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario. 3. Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario. 4. Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario.
Abstract
BACKGROUND: Hyperbilirubinemia is a common neonatal condition requiring timely management to prevent acute bilirubin encephalopathy. Management protocols allow nonphysicians to initiate designated actions prior to physician assessment. OBJECTIVE: To assess the effectiveness of a nurse-initiated neonatal jaundice management protocol for serum bilirubin sampling and phototherapy for neonates presenting with hyperbilirubinemia to the Paediatric Emergency Department (PED). METHODS: A health records review was performed for jaundiced neonates 12 months prior to the introduction of the management protocol (control period) and 12 months after (intervention period). Randomly selected charts were evaluated for time to serum bilirubin sampling, phototherapy initiation, ED length of stay, admission rate, completion of direct antiglobulin test and nursing documentation. RESULTS: Two hundred and sixty-six neonates (131 control and 135 intervention) were included. Median time to serum bilirubin sampling was reduced by 22% (36 min versus 28 min; P<0.001) with 34 min difference at the 90th percentile (94 min [95% confidence interval (CI) 63.7 to 116.9] versus 60 min [95% CI 49.0 to 78.2]). Statistically significant improvements were found in time to phototherapy initiation (127 min [95% CI 72.0 to 160.7] versus 65 min [95% CI 50.0 to 72.4] at 90th percentile), ED length of stay (267 min [95% CI 180.9 to 292.9] versus 216 min [95% CI 171.1 to 247.4] at 90th percentile) and hospital admissions (36% versus 17%; P<0.001). Improvements were also observed in direct antiglobulin test measurement (P<0.001) and nursing documentation (P=0.017). CONCLUSIONS: Implementation of a PED neonatal jaundice management protocol was associated with improved timeliness and standardization of care for this common and important condition.
BACKGROUND: Hyperbilirubinemia is a common neonatal condition requiring timely management to prevent acute bilirubin encephalopathy. Management protocols allow nonphysicians to initiate designated actions prior to physician assessment. OBJECTIVE: To assess the effectiveness of a nurse-initiated neonatal jaundice management protocol for serum bilirubin sampling and phototherapy for neonates presenting with hyperbilirubinemia to the Paediatric Emergency Department (PED). METHODS: A health records review was performed for jaundiced neonates 12 months prior to the introduction of the management protocol (control period) and 12 months after (intervention period). Randomly selected charts were evaluated for time to serum bilirubin sampling, phototherapy initiation, ED length of stay, admission rate, completion of direct antiglobulin test and nursing documentation. RESULTS: Two hundred and sixty-six neonates (131 control and 135 intervention) were included. Median time to serum bilirubin sampling was reduced by 22% (36 min versus 28 min; P<0.001) with 34 min difference at the 90th percentile (94 min [95% confidence interval (CI) 63.7 to 116.9] versus 60 min [95% CI 49.0 to 78.2]). Statistically significant improvements were found in time to phototherapy initiation (127 min [95% CI 72.0 to 160.7] versus 65 min [95% CI 50.0 to 72.4] at 90th percentile), ED length of stay (267 min [95% CI 180.9 to 292.9] versus 216 min [95% CI 171.1 to 247.4] at 90th percentile) and hospital admissions (36% versus 17%; P<0.001). Improvements were also observed in direct antiglobulin test measurement (P<0.001) and nursing documentation (P=0.017). CONCLUSIONS: Implementation of a PED neonatal jaundice management protocol was associated with improved timeliness and standardization of care for this common and important condition.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Margaret Wolff; Dana Aronson Schinasi; Jane Lavelle; Naomi Boorstein; Joseph John Zorc Journal: Pediatrics Date: 2012-11-12 Impact factor: 7.124
Authors: Roger Zemek; Amy Plint; Martin H Osmond; Tom Kovesi; Rhonda Correll; Nicholas Perri; Nick Barrowman Journal: Pediatrics Date: 2012-03-19 Impact factor: 7.124
Authors: Andrew Dixon; Chantalle Clarkin; Nick Barrowman; Rhonda Correll; Martin H Osmond; Amy C Plint Journal: CMAJ Date: 2014-03-24 Impact factor: 8.262