A three-year review of newborn readmissions identified hyperbilirubinemia as the predominant diagnosis.  Our objective was to improve care/processes to reduce newborn risks and prevent readmissions. A CNS-led interdisciplinary team recommended and implemented evidence-based practice changes to improve outcomes and decrease readmissions

Design:

The  Iowa Model of Evidence Based Practice to Promote Quality Care

Patients/Participants:

 Term newborns and late preterm newborns discharged from Newborn Nursery and their mothers.

Methods:

An interdisciplinary team of hospital and community agencies reviewed literature, examined current practices, and identified strategies for changes to improve outcomes and decrease readmissions for hyperbilirubinemia.

Implementation Strategies: 

Evidence-based practice changes were led by nursing leadership, pediatricians, unit practice committee, and quality committee.  Education for nurses, pediatricians, social workers was essential. Interventions addressed improved risk assessment, breastfeeding support both in hospital and after discharge, timely availability of home phototherapy equipment, and establishment of consistent home health follow-up.  Collaboration and relationship-building between the health care system and community agencies were key to our success. The initiative was presented to third party pay for performance committee.

Results:  

Results included improved risk screening, bilirubin evaluation and trending. Priority lactation consultant support for at-risk newborns within 24 hours of birth and post-discharge lactation clinic for support and hyperbilirubinemia assessment contributed to improved outcomes. Home phototherapy equipment on the nursing unit through DME consignment facilitated timely discharge and early initiation/continuity of treatment.  Home health networks for newborns provided follow-up assessment and breastfeeding support. Pre-and post-implementation data included risk factors; gestational age; feeding methods, support and outcomes; discharge and readmission bilirubin levels; home health follow-up referrals; and home phototherapy initiation.  None of the newborns having home phototherapy were readmitted.  Post-implementation demonstrated a 75% reduction in readmissions.

Conclusion/Implications for nursing practice:

An interdisciplinary approach effectively addressed the risk of newborn hyperbilirubinemia.  Because bilirubin levels continue to increase after discharge from the hospital, continued assessment of the newborn that includes physiological data as well as breastfeeding support is essential. Establishing a network of home health care providers committed to providing specialized services for at-risk newborns has improved follow-up.  Providing home phototherapy equipment before discharge facilitates uninterrupted phototherapy for newborns and reduces family stress. Early initiation of home phototherapy has decreased newborn risk of injury by earlier initiation of treatment, prevented newborn-parent separation through hospitalization and reduced hospital costs that are unreimbursed by third party payers.  Each of these components has provided seamless care to these vulnerable newborns and has improved outcomes.

Keywords: Hyperbilirubinemia, readmission