Background Readmission rates for healthy term neonates with severe hyperbilirubinaemia has increased in recent years. In 2011, we implemented a comprehensive risk assessment based integrated care pathway situated in the community to monitor all jaundiced babies. The pathway comprises intensive feeding support; monitoring bilirubin levels at home with transcutaneous bilirubinometers (TcB) and total serum bilirubin (TsB); prompt referral to hospital when thresholds for treatment set at 340µmol/l was reached and a standardised weaning strategy for phototherapy dosage.
Aims To evaluate the impact of this pathway on variations in decision to treat, readmission rates for jaundiced babies and length of stay (LoS) before and after implementation.
Methods We analysed the case records and compared the outcomes for all healthy term babies who were readmitted to receive phototherapy between 1 June and 30 September 2010 with those of babies admitted during the same period in 2011. We used SPSS software for statistical analysis.
Results 2921 term babies were delivered during the two time epochs. 28/1468 (0.02 %) received phototherapy in 2010 compared with 19/1453 (0.013%) in 2011. The mean maximum bilirubin levels in 2010 was significantly lower at 292±64 µmol/l (range: 193–457) compared with 362+26.3 µmol/l (range: 323–433) in 2011. The LoS was significantly reduced at 45.5±26.7hr in 2011 compared with 87.2±53.8 hr in 2010.
Conclusions This study showed reduced readmission rate and a statistically significant reduction in the length of stay during readmission in the post intervention group despite a significantly increased maximum bilirubin level. In addition, there was improved consistency amongst professionals on when to refer babies for phototherapy.
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