1
|
Sukkar S, Lorusso G, Jananeh S, Harrison R, Martin MA, Grabois E, Ayarza MC, Raj R, Cohen K, Pal J, Garcia-Chacon L, Bayes LY. Decreasing Bilirubin Serum Tests in Healthy Newborns During Birth Hospitalization. Pediatrics 2023:191257. [PMID: 37170760 DOI: 10.1542/peds.2022-059474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES Substantial variability exists in hyperbilirubinemia screening and monitoring leading to unnecessary total serum bilirubin (TSB) testing in healthy newborns. We aimed to assess the impact of value-care interventions to decrease the monthly TSB testing rate per 100 patient-days among healthy newborns in our Mother-Baby Unit by 30% by June 2022. METHODS We formed a multidisciplinary team to review the current practice for ordering TSB among housestaff in our Mother-Baby Unit. We identified several themes: variation in clinical practice, fear of hyperbilirubinemia, and desire to act for high-intermediate risk bilirubin levels. The interventions consisted of obtaining faculty buy-in, redesigning the hyperbilirubinemia pathway, educating staff on high value-care, producing an instructional video, and prompting staff to incorporate a bilirubin risk assessment via smart phrases in our electronic health record. The primary outcome was the monthly TSB testing rate per 100 patient-days. Universal predischarge bilirubin screening, length of stay, phototherapy rates, and readmission rates were chosen as balancing measures. RESULTS The monthly rate of TSB testing was reduced from 51 to 26.3 TSB per 100 patient-days, representing a 48% reduction. This improvement was sustained for 12 months. The percentage of infants with at least 1 TSB measurement during birth hospitalization decreased from 48% to 30%. Predischarge bilirubin screening, length of stay, and readmission rates were unchanged. CONCLUSIONS Our quality improvement initiative led to a significant reduction in the monthly TSB testing per 100 patient-days in healthy newborns without evidence of harm.
Collapse
Affiliation(s)
- Sarah Sukkar
- Holtz Children's Hospital at Jackson Memorial Hospital, Miami, Florida
| | - Gabriella Lorusso
- Holtz Children's Hospital at Jackson Memorial Hospital, Miami, Florida
| | - Sara Jananeh
- Holtz Children's Hospital at Jackson Memorial Hospital, Miami, Florida
| | - Robin Harrison
- Holtz Children's Hospital at Jackson Memorial Hospital, Miami, Florida
| | - Mikki-Ann Martin
- Holtz Children's Hospital at Jackson Memorial Hospital, Miami, Florida
| | - Evan Grabois
- Holtz Children's Hospital at Jackson Memorial Hospital, Miami, Florida
| | | | - Reeja Raj
- Holtz Children's Hospital at Jackson Memorial Hospital, Miami, Florida
| | - Kathryn Cohen
- Holtz Children's Hospital at Jackson Memorial Hospital, Miami, Florida
| | - Jayati Pal
- Holtz Children's Hospital at Jackson Memorial Hospital, Miami, Florida
| | - Luis Garcia-Chacon
- Department of Pediatrics, Section of Hospital Medicine
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Liz Y Bayes
- Department of Pediatrics, Section of Hospital Medicine
- Miller School of Medicine, University of Miami, Miami, Florida
| |
Collapse
|
2
|
Cristofaro SL, Cleary SD, Wan CR, Broussard B, Chapman C, Haggard PJ, Jananeh S, Myers NL, Compton MT. Measuring trauma and stressful events in childhood and adolescence among patients with first-episode psychosis: initial factor structure, reliability, and validity of the Trauma Experiences Checklist. Psychiatry Res 2013; 210:618-25. [PMID: 23850437 PMCID: PMC3816125 DOI: 10.1016/j.psychres.2013.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/22/2013] [Accepted: 06/13/2013] [Indexed: 11/29/2022]
Abstract
Past trauma and stressful events, especially in childhood and adolescence, are common among individuals with serious mental illnesses like schizophrenia. Traumatic experiences are thought to be a socio-environmental risk factor not only for poorer outcomes, but also potentially for the onset of these disorders. Because improved measurement tools are needed, we developed and studied, among 205 first-episode psychosis patients, the factor structure, internal consistency reliability, and initial validity of the Trauma Experiences Checklist (TEC), our measure of trauma and stressful events during childhood/adolescence. We assessed validity of subscales using correlations with Childhood Trauma Questionnaire-Short Form, Parental Harsh Discipline, Violence Exposure, and TEC-Informant Version scores. Exploratory factor analysis resulted in two internally consistent subscales (Cronbach's α=0.79 and 0.80, respectively), interpersonal abuse and family stress, and violence, death, and legal involvement. Scores from the former subscale were substantially associated with CTQ-SF physical, emotional, and sexual abuse (r=0.42-0.57, all p<0.001) and Violence Exposure (r=0.49, p<0.001). On the other hand, violence, death, and legal involvement scores were most highly correlated with Violence Exposure (r=0.49, p<0.001), and not with most CTQ-SF subscales. The TEC is a potentially useful tool in assessing diverse traumatic life events across various social contexts during childhood and adolescence.
Collapse
Affiliation(s)
- Sarah L. Cristofaro
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, USA
| | - Sean D. Cleary
- The George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, DC, USA
| | - Claire Ramsay Wan
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, USA
| | - Beth Broussard
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Colby Chapman
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Patrick J. Haggard
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, USA
| | - Sara Jananeh
- University of Georgia, Department of Psychology, Athens, GA, USA
| | - Neely L. Myers
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Michael T. Compton
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
,Corresponding author. Tel.: +202 741 3554; fax: 202 741 2891.
| |
Collapse
|