Abstract
Background Baylor Scott and White Medical Center at Waxahachie (BSWMCW), a level 1 neonatal designated facility, had rising neonatal jaundice readmission rates for two fiscal years (1.7% - 2.6%). Based off literature review, this was above the average rate for hospitals with similar populations (0.5% - 2.0%). Neonatal jaundice readmissions have several effects on families and the neonate related to increased costs, stress on bonding, and increased risk for hospital acquired infections.
Objectives By June 30, 2019, BSWMCW will reduce the rolling neonatal jaundice readmission rate from 2.6% (July 1, 2017-June 30, 2018) to less than 1% (July 1, 2018 – June 30, 2019).
Methods A multidisciplinary committee met to identify why excessive neonatal jaundice readmissions occurred. Issues identified were inconsistent practices in starting and stopping phototherapy, timing of discharge, and timing of newborn follow up in infants with jaundice (figure 1). The team prioritized management of jaundice through recognizing plan of care modifications during the initial hospitalization which would impact newborn readmission rates. Initially, clear guidelines were created on when to start or stop phototherapy, including discharge criteria, followed by implementation of new supplementation guidelines. Donor milk was offered as an alternative to formula supplementation. In order to adhere to supplementation guidelines, standardized newborn weights at 24 hours of life was added. Finally, jaundice lab testing was required through BSWMCW inpatient lab prior to admission rather than accepting lab values from other facilities which were often found to be different (figure 2).
Results Overall, the rolling percentage of neonatal jaundice readmissions for BSWMCW decreased from 2.6% to 0.8%, meeting the goal of less than 1%. This was sustained through fiscal year 2019 (figure 3).
Conclusions Neonatal Jaundice readmission rates can be affected through standardizing jaundice management protocols. In changing the timing of neonatal weights, this improved neonatal care, even for those without jaundice.
