Yassar Arain1,2, Juan M Banda3,4, Joshua Faulkenberry5, Vinod K Bhutani1, Jonathan P Palma6,7. 1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA. 2. Division of Neonatology, UC San Diego, 9300 Campus Point Drive MC7774, La Jolla, California; Rady Children's Hospital-San Diego, 3020, Children's Way, San Diego, CA, USA. 3. Division of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. 4. Department of Computer Science, Georgia State University, Atlanta, GA, USA. 5. Department of Clinical Informatics, Stanford Children's Health, Stanford, CA, USA. 6. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA. jpalma@stanfordchildrens.org. 7. Department of Clinical Informatics, Stanford Children's Health, Stanford, CA, USA. jpalma@stanfordchildrens.org.
Abstract
OBJECTIVE: Adherence to guidelines for phototherapy initiation in preterm infants was 39% in our academic NICU (61% of phototherapy was initiated at total bilirubin (TB) levels below recommended thresholds). We hypothesized that adoption of an electronic health record integrated clinical decision support (CDS) tool would improve adherence to phototherapy guidelines. STUDY DESIGN: We developed and implemented Premie BiliRecs (PBR), a novel CDS tool for phototherapy initiation in preterm infants from 27 through 34 weeks postmenstrual age. The primary outcome measure was the proportion of phototherapy initiation events consistent with recommended TB thresholds. RESULT: Following the implementation of PBR, adherence to guidelines for phototherapy initiation in preterm infants increased to 69.8% (p < 0.001), an improvement of 77%. There was no increase in the incidence of severe hyperbilirubinemia nor exchange transfusions. CONCLUSION: The adoption of PBR was associated with improved adherence to phototherapy guidelines in preterm infants without increased adverse events.
OBJECTIVE: Adherence to guidelines for phototherapy initiation in preterm infants was 39% in our academic NICU (61% of phototherapy was initiated at total bilirubin (TB) levels below recommended thresholds). We hypothesized that adoption of an electronic health record integrated clinical decision support (CDS) tool would improve adherence to phototherapy guidelines. STUDY DESIGN: We developed and implemented Premie BiliRecs (PBR), a novel CDS tool for phototherapy initiation in preterm infants from 27 through 34 weeks postmenstrual age. The primary outcome measure was the proportion of phototherapy initiation events consistent with recommended TB thresholds. RESULT: Following the implementation of PBR, adherence to guidelines for phototherapy initiation in preterm infants increased to 69.8% (p < 0.001), an improvement of 77%. There was no increase in the incidence of severe hyperbilirubinemia nor exchange transfusions. CONCLUSION: The adoption of PBR was associated with improved adherence to phototherapy guidelines in preterm infants without increased adverse events.