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G133(P) Management of Prolonged Jaundice in Nurse-Led Clinics – 10 Years of a Safe and Efficient Service
  1. M Hyrapetian1,2,
  2. R J Hewitson1,
  3. H Mackinnon1
  1. 1General Paediatrics, The Whittington Hospital NHS Trust, London, UK
  2. 2Paediatrics, London School of Paediatrics, London, UK

Abstract

Aims Prolonged jaundice in babies is common and usually harmless but a very small number of cases have serious pathology, such as biliary atresia, in which early detection is vital. Many “well” babies with prolonged jaundice undergo extensive investigations with a very low yield of important positive results. Our aim was to assess the safety, efficiency and cost effectiveness of a nurse-led prolonged jaundice clinic which has been in operation at our district general hospital for ten years, performing minimal investigations compared to standard practise.

Methods We collected data retrospectively for all babies <3months of age in whom a conjugated bilirubin level was measured at ≥14 days of age (term) or ≥21 days (preterm) from January-August 2011, excluding babies on the neonatal unit. We reviewed clinic proformas completed for each baby seen with prolonged jaundice, medical notes and hospital results system to establish whether the baby was managed in the nurse led prolonged jaundice clinic or elsewhere by doctors, investigations undertaken and clinical outcomes.

Results 91% (176) of 194 babies were managed in the nurse led prolonged jaundice clinic; 5.6% (10) had additional investigations which identified one case with significant pathology. Of the 9% (18) of babies seen elsewhere by doctors (A&E/outpatients/inpatients/daycare), 77% (14) had additional investigations. 3 babies had serious pathology including one case of biliary atresia which presented late (48 days old).

Conclusion For the last ten years we have managed the vast majority of babies with prolonged jaundice in our nurse-led clinic, successfully avoiding unnecessary, time-consuming and expensive investigations for well babies whilst promptly identifying cases with serious pathology.

Our district general hospital has recently merged with two local community health services to form an Integrated Care Organisation, providing a unique opportunity to move the nurse-led prolonged jaundice clinic into the community. Based on our well established model, such clinics could be conducted in local health centres by midwives or community paediatric nurses, supervised by a consultant paediatrician. This would allow further cost savings and be more convenient for families.

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