Comparing Outcomes Between Direct and ED Admissions for Neonatal Hyperbilirubinemia
Comparing Outcomes Between Direct and ED Admissions for Neonatal Hyperbilirubinemia https://pediatricsnationwide.org/wp-content/uploads/2021/01/89925896-1-1024x681.jpg 1024 681 Pam Georgiana Pam Georgiana https://pediatricsnationwide.org/wp-content/uploads/2023/07/May-2023.jpg- July 12, 2024
- Pam Georgiana
Does the method of admission affect care for patients with neonatal hyperbilirubinemia?
Neonatal hyperbilirubinemia, with jaundice as its primary symptom, can be scary for parents of newborns. This condition requires a blood test to measure bilirubin levels for diagnosis. Despite its concerning appearance, hyperbilirubinemia is very treatable, and patients are usually at low risk for complications. Phototherapy is the standard of care for treatment of moderate to severe cases of neonatal hyperbilirubinemia and often requires hospital admission.
Some patients receive treatment through an emergency department (ED) visit and admission, while others are directly admitted from a primary care office after a first newborn visit. Ashleigh J. Slemmer, DO, MBA, assistant clinical professor in Hospital Medicine at Nationwide Children’s Hospital, and a team of researchers wanted to study the outcomes and resource utilization of both methods of admission. The study was recently published in Hospital Pediatrics.
They compared 1,098 patients admitted to Nationwide Children’s with a primary diagnosis of neonatal hyperbilirubinemia between 2017 and 2021. Patients were between 24 hours and 14 days old and had gestational ages of ≥35 weeks. The team researched outcomes, including length of stay (LOS), time to starting phototherapy, transfer to the Newborn Intensive Care Unit (NICU), 7-day readmission for phototherapy, and resource utilization. “Hospitalization can be very stressful for a baby and parents,” Dr. Slemmer acknowledges. “We hoped that our findings would support new parents, especially first-time parents, in understanding and anticipating their child’s experience at the hospital.”
The research revealed that patients who are directly admitted experienced a shorter median time to bilirubin level testing, received less intravenous fluids and bilirubin lab draws, received phototherapy sooner, and had a shorter LOS. One directly admitted patient required transfer to the NICU. There were no differences in 7-day readmission rates for phototherapy.
“The data tells us that there may be very few cases in which admission through the ED is necessary for the management of neonatal hyperbilirubinemia,” Dr. Slemmer says. “With the added risk of infection and a longer wait time for phototherapy initiation in most EDs, it likely makes more sense for patients with this diagnosis to instead be admitted from their primary care provider’s office.”
Because not many pediatric hospitals have a direct admission process, including for neonatal hyperbilirubinemia, many families must go through an ED to be admitted.
“Our study suggests that direct admissions for neonatal hyperbilirubinemia result in improved resource utilization and timeliness to clinical care, contributing to a more efficient health care system,” Dr. Slemmer concludes.
This study provides evidence that hospitals should consider adding a direct admission process for infants with neonatal hyperbilirubinemia as a safe and likely cost-effective alternative to ED admission.
Reference:
Slemmer A, Klamer B, Schmerge C, Lauden S, Texler C, Fennell M, Lowing D, Leyenaar JK, Bode RS. Comparing outcomes between direct and ED admissions for neonatal hyperbilirubinemia. Hospital Pediatrics. 2024;14(6):421-429.
Image credit: Adobe Stock
About the author
Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.
- Pam Georgianahttps://pediatricsnationwide.org/author/pam-georgiana/
- Pam Georgianahttps://pediatricsnationwide.org/author/pam-georgiana/
- Pam Georgianahttps://pediatricsnationwide.org/author/pam-georgiana/
- Pam Georgianahttps://pediatricsnationwide.org/author/pam-georgiana/
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