PM2054: Prophylactic Home Phototherapy to Prevent Neonatal Hyperbilirubinemia Readmissions

Purpose/Objectives: This project aims to reduce readmission rate of neonatal hyperbilirubinemia by 20% in neonates with GA ≥ 36 weeks and TSB 2 mg/dl below PT threshold by using Home Biliblanket over 24 months and to compare the nursery length of stay between the pre intervention and Home Biliblanket groups.

Design/Methods: Plan-Do-Study-Act (PDSA)
1. Developed criteria to evaluate newborn at risk for indirect hyperbilirubinemia prior to initial discharge (Figure 1)
2. Determine the baseline readmission rate: retrospectively searched hospital database of a comparison pre-intervention group who met the same inclusion criteria within a 2 year period
3. Developed standardized process to initiate home PT
4. Created a process to have DME readily available when home PT is ordered
5. Increased provider awareness of availability, process, and beneficial outcomes of home PT
6. Developed standardized education for parents for prevention and treatment of hyperbilirubinemia
7. Estimated the readmission rate of Biliblanket group monthly over 24 months period

Results: In our pre-intervention group, 90 patients met the inclusion criteria in which 74 patients (82%) received conventional PT in the hospital and 16 patients (17.7%) were discharged with PCP follow up. Of those 16 patients, three (19%) got readmitted. In the Home Biliblanket group, 35 patients met the inclusion criteria with 0% readmission. The P-value of Fischer’s exact test was 0.027. The mean length of stay in the pre-intervention group was 76 hours. The mean length of stay in Biliblanket group was 53 hours (P-value of Welch 2 sample t-test < 0.001). Average length of stay on the general floor is 1.19 days and costs $3801. Average length of time Bili Blanket used is 3.23 days and costs $402. Home Biliblanket is 9x cheaper, over $3000 saved per neonate.

Conclusion/Discussion: Home phototherapy is a safe and cost-effective way to prevent readmissions and reduce nursery length of stay. Home phototherapy should be considered when TSB is ≤ 2mg/dL below the treatment threshold at discharge from birth hospitalization in neonates without neurotoxic risk factors.