P2C029: Improving the Discharge Management of Hyperbilirubinemia in the Newborn Nursery

Purpose/Objectives: In September 2022, the American Academy of Pediatrics (AAP) revised the clinical guideline for the management of hyperbilirubinemia. A new component addresses the need to provide both written and verbal education to families about newborn jaundice. The written information should facilitate post-discharge care and include at least the infant’s last bilirubin measurement, the age at which it was measured, and direct antigen test (DAT) results. This information should be transmitted to the patient's primary care provider (PCP). In this study, investigators aimed to provide verbal and written education to families to elicit full understanding of newborn jaundice, as well as follow-up instructions and information for PCP to at least 80% of families in the newborn nursery at time of hospital discharge.

Design/Methods: Investigators implemented this quality improvement initiative in a tertiary care hospital nursery. The primary outcome measure was the percentage of parents who received verbal and written information and the process measure was how parents rated their understanding of the information provided. Investigators measured both via pre- and post-intervention surveys. Interventions included providing verbal and written education to parents about neonatal jaundice, latest bilirubin level and the age at which it was measured, DAT results, and resident training on effectively providing verbal education to families regarding newborn jaundice. The intervention tool, a handout developed by investigators, served as both education for parents and communication to the PCP.

Results: Investigators collected baseline data from 100 families and post-intervention data from 50 families thus far using pre- and post-intervention surveys at time of discharge, respectively. Data showed significant improvement in primary outcome measures. Following the interventions, 78% of families felt that they had a full understanding of jaundice, compared to 21% in the pre-intervention group. Additionally, 98% of families stated they received written education and follow-up materials about jaundice and 100% knew their baby's last bilirubin level, compared to 16% in the pre-intervention for both measures.

Conclusion/Discussion: This study shows post-intervention improvement in parental understanding of jaundice and knowledge of their child’s bilirubin level at discharge from nursery. Nearly all families surveyed received verbal and written information about jaundice, in compliance with the latest AAP guidelines. The intervention tool incorporates pertinent information about the patient for the PCP, improving physician hand-off. This highlights the importance of physician-directed family education and physician hand-off in improved discharge management of hyperbilirubinemia. Henceforth, investigators plan to continue promoting and encouraging the use of the intervention tool and distribution of consistent verbal education to families in the nursery by in-house physicians. Furthermore, investigators plan for additional educational sessions for house-staff, nursing staff, and pediatricians in the nursery regarding the importance of jaundice education and compliance with the most recent AAP clinical practice guidelines.