A Children’s Hospital in Seattle (SCH), Washington witnessed a high degree of variation in the care of neonatal jaundice. The practitioners generally followed the American Academy of Pediatrics (AAP) recommendations for initiation of treatment but had concerns about the breadth and frequency of laboratory testing or timing of therapy cessation. “Rebound” testing, or bilirubin monitoring after cessation of therapy, Light administration all were matters of concern. They were free to select any combination of phototherapy modalities. Thus they sought to optimize the value equation for neonatal jaundice patients by creating a standard care pathway.

They created an evidence-based pathway for the management of neonatal jaundice by utilizing multidisciplinary team assembly, comprehensive literature review, creation of a treatment algorithm and computer order sets, formulation of goals and metrics, roll-out of an education program for end-users, and ongoing pathway improvement. 

They noticed significant improvements across multiple quality dimensions-

• Time to recovery decreased: from 1.30 days for pre pathway patients to 0.87 days for post pathway patients.
• Efficiency was enhanced: mean time to phototherapy initiation decreased from 101.26 minutes for pre pathway patients to 54.67 minutes for post pathway patients.
• Care was less invasive: intravenous fluid orders were reduced from 80% to 44%.
• Reduction in Inpatient use: 66% of pre pathway patients admitted from the emergency department to inpatient care, reduced to 50% of post pathway patients.
• No increase in the readmission rate.
• These all led to significant cost reductions in total charges, including intravenous fluids, laboratory, room cost, and emergency department charges.

Thus the authors concluded that an evidence-based standard care pathway for neonatal jaundice can significantly improve multiple dimensions of value, including reductions in cost and length of stay.

Source: Pediatrics. 2018 Mar;141(3):e20161472. doi: 10.1542/peds.2016-1472. Epub 2018 Feb 21. PMID: 29467276.