Clinical Decision Support for Hyperbilirubinemia Risk Assessment in the Electronic Health Record

Petersen, John D.; Lozovatsky, Margaret; Markovic, Daniela; Duncan, Ray; Zheng, Simon; Shamsian, Arash; Kagele, Sonya; Ross, Mindy K.

doi:10.1016/j.acap.2020.02.009

Cited by 9 publications

(7 citation statements)

References 9 publications

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“…11 CDS usage in a variety of settings has been associated with improved patient care processes or outcomes for these diagnoses. [12][13][14][15][16][17][18][19] The survey included EHR vendor-agnostic operational definitions of each CDS tool type that appeared when the respondent hovered over the corresponding response option to aid in their understanding. Upon receipt of the survey invitation, site leads were given the option to forward the invitation to a colleague more familiar with CDS at their site.…”

Section: Methodsmentioning

confidence: 99%

“…Diagnoses were chosen based upon epidemiologic research identifying the most frequently encountered conditions in inpatient pediatric hospital medicine 11 . CDS usage in a variety of settings has been associated with improved patient care processes or outcomes for these diagnoses 12–19 . The survey included EHR vendor‐agnostic operational definitions of each CDS tool type that appeared when the respondent hovered over the corresponding response option to aid in their understanding.…”

Section: Methodsmentioning

confidence: 99%

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Between‐hospital variation in clinical decision support availability for common inpatient pediatric conditions: Results of a national Pediatric Research in Inpatient Settings (PRĪS) Network survey

Carr

Oluwalade

Muthu

et al. 2023

Journal of Hospital Medicine

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Implementing pediatric‐focused clinical decision support (CDS) into hospital electronic health records can lead to improvements in patient care and accelerate quality improvement and research initiatives. However, its design, development, and implementation can be a time‐consuming and costly endeavor that may not be feasible for all hospital settings. In this cross‐sectional study, we surveyed Pediatric Research in Inpatient Settings (PRĪS) Network hospitals about the availability of CDS tools to gain an understanding of the functionality available across 8 common inpatient pediatric diagnoses. Among the conditions, asthma had the most extensive CDS availability, while mood disorders had the least. Overall, freestanding children's hospitals had the greatest breadth in CDS coverage across conditions and depth in CDS types within conditions. Future initiatives should examine the relationship between CDS availability and clinical outcomes as well as its relationship with hospitals’ performance executing multicenter informatics projects, quality improvement collaboratives, and implementation science strategies.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Between‐hospital variation in clinical decision support availability for common inpatient pediatric conditions: Results of a national Pediatric Research in Inpatient Settings (PRĪS) Network survey

Carr

Oluwalade

Muthu

et al. 2023

Journal of Hospital Medicine

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“…However, transcribing data into an external website is inefficient and is vulnerable to a transcription error. Petersen et al evaluated the integration of neonatal hyperbilirubinaemia risk assessment into the EHR and concluded that EHR integration may decrease errors and further increase adherence to guidelines 13. These publications demonstrate that web-based clinical decision support tools alone can increase adherence to guidelines but that integration of these tools into the EHR may have an additional benefit.…”

Section: Introductionmentioning

confidence: 99%

Increasing utilisation of a rebound hyperbilirubinaemia calculator in two newborn nurseries

Germana

Shaikh

2023

BMJ Open Qual

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Neonatal hyperbilirubinaemia requiring phototherapy treatment is a common problem impacting the length of hospital stay and rates of hospital readmission. Previous guidelines included guidance for initiating phototherapy treatment but not for discontinuing phototherapy treatment during initial newborn admission.In response to dissatisfaction from trainees, staff and families regarding the variable approach to discontinuing phototherapy among attending nursery providers, we used quality improvement methodologies to increase utilisation of a rebound hyperbilirubinaemia calculator as a more consistent method for guiding the timing of phototherapy discontinuation. The aim was to increase utilisation of the rebound hyperbilirubinaemia calculator for newborns treated with phototherapy in two newborn nurseries to >90% within 2 years.Sequential interventions focused on increasing provider awareness of the rebound hyperbilirubinaemia calculator and making the calculator simple to access and use.At the university medical centre nursery, the use of the calculator increased from 8.7% to 100%, exceeding the project goal. In the community hospital nursery, there was a statistically significant increase in the rate of utilisation from 3.7% to 79.4%, but this fell slightly below the goal of >90%.Electronic Health Record integration, along with education and addition of prompts to providers, increased utilisation of a rebound hyperbilirubinaemia calculator as a consistent approach for guiding decisions about discontinuing phototherapy treatment in newborns.

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“…For example, aggressive hemolysis or delay in starting phototherapy may result in high bilirubin levels leading to acute bilirubin encephalopathy and kernicterus. 4,5 In case of maternal and fetal blood group mismatch, maternal antibodies, if present, against fetal RBCs cross into the foetus, either trans-placentally during pregnancy or at the time of separation of placenta. 6 These antibodies cause fetal/neonatal RBC's haemolysis, leading to anaemia and hyperbilirubinemia.…”

Section: Introductionmentioning

confidence: 99%

Utility of Direct Coomb’s test in a Tertiary Care Nursery

Ahmed,

Anwar,

Gul

et al. 2023

PAFMJ

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Objective: To document the causes and clinical significance of direct Coomb’s test distal convoluted tubule in neonatal Jaundice at a tertiary care setup. Study Design: Cross-sectional study. Place and Duration of the Study: Fatima Memorial Hospital, Lahore Pakistan, from Nov 2019 to Oct 2020. Methodology: All babies born to “O” or Rh-negative blood group mothers were included. In addition, data including demographics, mother’s blood group, baby’s blood group, direct Coomb’s test results, bilirubin values, and need for treatment was recorded. Results: The study included 989 neonates. Of all, 489(49.4%) were male, the mean birth weight was 2.80±0.75 kg, and the mean gestation was 36±4.3 weeks. ABO mismatch was present in 452(45.7%) cases and Rh mismatch in 123(12.4%). Of all, 58(5.9%) had positive direct Coomb’s test. Amongst the positive direct Coomb’s test patients, 44(75.8%) babies needed treatment, of which 40(90.9%) received phototherapy, and 4(6.8%) needed Intensive phototherapy (360 degrees). No baby needed an exchange transfusion. Conclusion: In most cases, positive direct Coomb’s test was due to ABO blood group incompatibility. In addition, early phototherapy can control bilirubin rise in most cases, so few would need aggressive or intensive treatment.Keywords: ABO mismatch, Direct Coomb’s test, Neonatal jaundice, Rh mismatch.

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Clinical Decision Support for Hyperbilirubinemia Risk Assessment in the Electronic Health Record

Cited by 9 publications

References 9 publications

Between‐hospital variation in clinical decision support availability for common inpatient pediatric conditions: Results of a national Pediatric Research in Inpatient Settings (PRĪS) Network survey

Between‐hospital variation in clinical decision support availability for common inpatient pediatric conditions: Results of a national Pediatric Research in Inpatient Settings (PRĪS) Network survey

Increasing utilisation of a rebound hyperbilirubinaemia calculator in two newborn nurseries

Utility of Direct Coomb’s test in a Tertiary Care Nursery

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