Implementation and Assessment of a SmartZone Alert to Notify Clinicians of Critical Hyperbilirubinemia in Preterm Infants Less Than 35 Weeks Gestation
Abstract Background Neonatal jaundice, also known as hyperbilirubinemia in term and preterm infants, is treated with phototherapy when bilirubin results exceed gestational age- and age-specific medical decision levels (MDL) to prevent kernicterus and bilirubin-induced neurological damage. During pho...
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| Veröffentlicht in: | American journal of clinical pathology 2022-11, Vol.158 (Supplement_1), p.S27-S28 |
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| creator | Xiao, Yi Palmucci, Mandy Carlin, Lance Lee, Catherine O'Gorman, Maurice Nair, Srikumar Yieh, Leah Leung, Edward |
| description | Abstract
Background
Neonatal jaundice, also known as hyperbilirubinemia in term and preterm infants, is treated with phototherapy when bilirubin results exceed gestational age- and age-specific medical decision levels (MDL) to prevent kernicterus and bilirubin-induced neurological damage. During phototherapy, unconjugated bilirubin is converted to water-soluble isomers that are excreted in the urine. Presently, the electronic medical record (EMR) at our hospital cannot use gestational age to stratify reference ranges thereby the associated flags and alerts would not be triggered, leading to delays in reviewing bilirubin results and placing phototherapy orders. The aim of this project is to replace the current manual assessment process for phototherapy with a newly designed alert to notify clinicians of elevated bilirubin results for preterm infants ( |
| doi_str_mv | 10.1093/ajcp/aqac126.049 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2823838849</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ajcp/aqac126.049</oup_id><sourcerecordid>2823838849</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1479-ebcab6c1c1eea0e64f4e22c1d1a23c491632ebaa1b170a7bb6a0c1222d56700b3</originalsourceid><addsrcrecordid>eNqFkE1rGzEQhkVooW6ae48DOYZNRtJmP47GpInBtIWmFHJZRvIskbMrbST54D-S39t1nXtPA8Pzzjs8QnyVeC2x1Te0s9MNvZKVqrrGsj0TC9mWuqhrpT6IBSKqopW1_iQ-p7RDlKrBciHe1uM08Mg-U3bBA_ktLFPilI47CD0Q_Bop5qfgGZYDxww5wPeQXX-A1eC8s458OpKr6LKzNMDDYeJo3ODi3jjPoyNwHn5GzhxHWPuefE6wmUvg8Zk86Fv4w_yS4J7T6Y8v4mNPQ-KL93kufn-7e1w9FJsf9-vVclNYWdZtwcaSqay0kpmQq7IvWSkrt5KUtmUrK63YEEkja6TamIpwFqTU9raqEY0-F5enu1MMr_u5vduFffRzZacapRvdNGU7U3iibAwpRe67KbpZyqGT2B3td0f73bv9Dv9Frk6RsJ_-T_8Fr6yKqQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2823838849</pqid></control><display><type>article</type><title>Implementation and Assessment of a SmartZone Alert to Notify Clinicians of Critical Hyperbilirubinemia in Preterm Infants Less Than 35 Weeks Gestation</title><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Xiao, Yi ; Palmucci, Mandy ; Carlin, Lance ; Lee, Catherine ; O'Gorman, Maurice ; Nair, Srikumar ; Yieh, Leah ; Leung, Edward</creator><creatorcontrib>Xiao, Yi ; Palmucci, Mandy ; Carlin, Lance ; Lee, Catherine ; O'Gorman, Maurice ; Nair, Srikumar ; Yieh, Leah ; Leung, Edward</creatorcontrib><description>Abstract
Background
Neonatal jaundice, also known as hyperbilirubinemia in term and preterm infants, is treated with phototherapy when bilirubin results exceed gestational age- and age-specific medical decision levels (MDL) to prevent kernicterus and bilirubin-induced neurological damage. During phototherapy, unconjugated bilirubin is converted to water-soluble isomers that are excreted in the urine. Presently, the electronic medical record (EMR) at our hospital cannot use gestational age to stratify reference ranges thereby the associated flags and alerts would not be triggered, leading to delays in reviewing bilirubin results and placing phototherapy orders. The aim of this project is to replace the current manual assessment process for phototherapy with a newly designed alert to notify clinicians of elevated bilirubin results for preterm infants (<35 weeks gestation) and to minimize prolonged delays in placing phototherapy orders. We hypothesized that the SmartZone alert will encourage consistent and timely consideration of phototherapy.
Method
A SmartZone alert, built with Cerner command language and Discern Expert rules, evaluates total or neonatal bilirubin results for patients in the Newborn and Infant Critical Care Unit (NICCU), calculates the patient’s age using the recorded gestational age and birth time, and utilizes the following rules: 1) bilirubin result must exceed the pre-defined gestational age-specific MDLs, and 2) calculated gestational age is <35 weeks. Additionally, the SmartZone alert will not be triggered if there is an active phototherapy order. Once triggered, the alert will be visible for four hours to all caregivers who view the patient’s EMR. We compared the duration of time between verified bilirubin results and phototherapy orders before and after the implementation of the SmartZone alert.
Result
The SmartZone alert was implemented on 01/11/2022. Between 1/1/2021 - 1/11/2022, 95 preterm infants in the NICCU had neonatal and total bilirubin results, in which 19 met the criteria for the alert to be triggered, and 17 had phototherapy orders. Further analysis revealed that 12 orders were placed <24 hours, four orders were placed 24 - 72 hours, and one order was placed >72 hours after bilirubin results were verified. Between 1/12/2022 – 2/13/2022, 13 newly admitted preterm infants in the NICCU had neonatal and total bilirubin results, in which one triggered the alert, and phototherapy was ordered within 15 hours.
Conclusion
A SmartZone alert was implemented to encourage consistent and timely consideration of phototherapy for preterm infants <35 weeks with critical hyperbilirubinemia. The alert is functioning as intended. This alert will be continuously monitored to further optimize its functionality and utilization.</description><identifier>ISSN: 0002-9173</identifier><identifier>EISSN: 1943-7722</identifier><identifier>DOI: 10.1093/ajcp/aqac126.049</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Age ; Bilirubin ; Electronic medical records ; Gestational age ; Hyperbilirubinemia ; Infants ; Isomers ; Jaundice ; Light therapy ; Neonates ; Newborn babies ; Patients ; Phototherapy ; Premature babies</subject><ispartof>American journal of clinical pathology, 2022-11, Vol.158 (Supplement_1), p.S27-S28</ispartof><rights>American Society for Clinical Pathology, 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2022</rights><rights>American Society for Clinical Pathology, 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids></links><search><creatorcontrib>Xiao, Yi</creatorcontrib><creatorcontrib>Palmucci, Mandy</creatorcontrib><creatorcontrib>Carlin, Lance</creatorcontrib><creatorcontrib>Lee, Catherine</creatorcontrib><creatorcontrib>O'Gorman, Maurice</creatorcontrib><creatorcontrib>Nair, Srikumar</creatorcontrib><creatorcontrib>Yieh, Leah</creatorcontrib><creatorcontrib>Leung, Edward</creatorcontrib><title>Implementation and Assessment of a SmartZone Alert to Notify Clinicians of Critical Hyperbilirubinemia in Preterm Infants Less Than 35 Weeks Gestation</title><title>American journal of clinical pathology</title><description>Abstract
Background
Neonatal jaundice, also known as hyperbilirubinemia in term and preterm infants, is treated with phototherapy when bilirubin results exceed gestational age- and age-specific medical decision levels (MDL) to prevent kernicterus and bilirubin-induced neurological damage. During phototherapy, unconjugated bilirubin is converted to water-soluble isomers that are excreted in the urine. Presently, the electronic medical record (EMR) at our hospital cannot use gestational age to stratify reference ranges thereby the associated flags and alerts would not be triggered, leading to delays in reviewing bilirubin results and placing phototherapy orders. The aim of this project is to replace the current manual assessment process for phototherapy with a newly designed alert to notify clinicians of elevated bilirubin results for preterm infants (<35 weeks gestation) and to minimize prolonged delays in placing phototherapy orders. We hypothesized that the SmartZone alert will encourage consistent and timely consideration of phototherapy.
Method
A SmartZone alert, built with Cerner command language and Discern Expert rules, evaluates total or neonatal bilirubin results for patients in the Newborn and Infant Critical Care Unit (NICCU), calculates the patient’s age using the recorded gestational age and birth time, and utilizes the following rules: 1) bilirubin result must exceed the pre-defined gestational age-specific MDLs, and 2) calculated gestational age is <35 weeks. Additionally, the SmartZone alert will not be triggered if there is an active phototherapy order. Once triggered, the alert will be visible for four hours to all caregivers who view the patient’s EMR. We compared the duration of time between verified bilirubin results and phototherapy orders before and after the implementation of the SmartZone alert.
Result
The SmartZone alert was implemented on 01/11/2022. Between 1/1/2021 - 1/11/2022, 95 preterm infants in the NICCU had neonatal and total bilirubin results, in which 19 met the criteria for the alert to be triggered, and 17 had phototherapy orders. Further analysis revealed that 12 orders were placed <24 hours, four orders were placed 24 - 72 hours, and one order was placed >72 hours after bilirubin results were verified. Between 1/12/2022 – 2/13/2022, 13 newly admitted preterm infants in the NICCU had neonatal and total bilirubin results, in which one triggered the alert, and phototherapy was ordered within 15 hours.
Conclusion
A SmartZone alert was implemented to encourage consistent and timely consideration of phototherapy for preterm infants <35 weeks with critical hyperbilirubinemia. The alert is functioning as intended. This alert will be continuously monitored to further optimize its functionality and utilization.</description><subject>Age</subject><subject>Bilirubin</subject><subject>Electronic medical records</subject><subject>Gestational age</subject><subject>Hyperbilirubinemia</subject><subject>Infants</subject><subject>Isomers</subject><subject>Jaundice</subject><subject>Light therapy</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>Patients</subject><subject>Phototherapy</subject><subject>Premature babies</subject><issn>0002-9173</issn><issn>1943-7722</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqFkE1rGzEQhkVooW6ae48DOYZNRtJmP47GpInBtIWmFHJZRvIskbMrbST54D-S39t1nXtPA8Pzzjs8QnyVeC2x1Te0s9MNvZKVqrrGsj0TC9mWuqhrpT6IBSKqopW1_iQ-p7RDlKrBciHe1uM08Mg-U3bBA_ktLFPilI47CD0Q_Bop5qfgGZYDxww5wPeQXX-A1eC8s458OpKr6LKzNMDDYeJo3ODi3jjPoyNwHn5GzhxHWPuefE6wmUvg8Zk86Fv4w_yS4J7T6Y8v4mNPQ-KL93kufn-7e1w9FJsf9-vVclNYWdZtwcaSqay0kpmQq7IvWSkrt5KUtmUrK63YEEkja6TamIpwFqTU9raqEY0-F5enu1MMr_u5vduFffRzZacapRvdNGU7U3iibAwpRe67KbpZyqGT2B3td0f73bv9Dv9Frk6RsJ_-T_8Fr6yKqQ</recordid><startdate>20221109</startdate><enddate>20221109</enddate><creator>Xiao, Yi</creator><creator>Palmucci, Mandy</creator><creator>Carlin, Lance</creator><creator>Lee, Catherine</creator><creator>O'Gorman, Maurice</creator><creator>Nair, Srikumar</creator><creator>Yieh, Leah</creator><creator>Leung, Edward</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>20221109</creationdate><title>Implementation and Assessment of a SmartZone Alert to Notify Clinicians of Critical Hyperbilirubinemia in Preterm Infants Less Than 35 Weeks Gestation</title><author>Xiao, Yi ; Palmucci, Mandy ; Carlin, Lance ; Lee, Catherine ; O'Gorman, Maurice ; Nair, Srikumar ; Yieh, Leah ; Leung, Edward</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1479-ebcab6c1c1eea0e64f4e22c1d1a23c491632ebaa1b170a7bb6a0c1222d56700b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Age</topic><topic>Bilirubin</topic><topic>Electronic medical records</topic><topic>Gestational age</topic><topic>Hyperbilirubinemia</topic><topic>Infants</topic><topic>Isomers</topic><topic>Jaundice</topic><topic>Light therapy</topic><topic>Neonates</topic><topic>Newborn babies</topic><topic>Patients</topic><topic>Phototherapy</topic><topic>Premature babies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Xiao, Yi</creatorcontrib><creatorcontrib>Palmucci, Mandy</creatorcontrib><creatorcontrib>Carlin, Lance</creatorcontrib><creatorcontrib>Lee, Catherine</creatorcontrib><creatorcontrib>O'Gorman, Maurice</creatorcontrib><creatorcontrib>Nair, Srikumar</creatorcontrib><creatorcontrib>Yieh, Leah</creatorcontrib><creatorcontrib>Leung, Edward</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>American journal of clinical pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Xiao, Yi</au><au>Palmucci, Mandy</au><au>Carlin, Lance</au><au>Lee, Catherine</au><au>O'Gorman, Maurice</au><au>Nair, Srikumar</au><au>Yieh, Leah</au><au>Leung, Edward</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementation and Assessment of a SmartZone Alert to Notify Clinicians of Critical Hyperbilirubinemia in Preterm Infants Less Than 35 Weeks Gestation</atitle><jtitle>American journal of clinical pathology</jtitle><date>2022-11-09</date><risdate>2022</risdate><volume>158</volume><issue>Supplement_1</issue><spage>S27</spage><epage>S28</epage><pages>S27-S28</pages><issn>0002-9173</issn><eissn>1943-7722</eissn><abstract>Abstract
Background
Neonatal jaundice, also known as hyperbilirubinemia in term and preterm infants, is treated with phototherapy when bilirubin results exceed gestational age- and age-specific medical decision levels (MDL) to prevent kernicterus and bilirubin-induced neurological damage. During phototherapy, unconjugated bilirubin is converted to water-soluble isomers that are excreted in the urine. Presently, the electronic medical record (EMR) at our hospital cannot use gestational age to stratify reference ranges thereby the associated flags and alerts would not be triggered, leading to delays in reviewing bilirubin results and placing phototherapy orders. The aim of this project is to replace the current manual assessment process for phototherapy with a newly designed alert to notify clinicians of elevated bilirubin results for preterm infants (<35 weeks gestation) and to minimize prolonged delays in placing phototherapy orders. We hypothesized that the SmartZone alert will encourage consistent and timely consideration of phototherapy.
Method
A SmartZone alert, built with Cerner command language and Discern Expert rules, evaluates total or neonatal bilirubin results for patients in the Newborn and Infant Critical Care Unit (NICCU), calculates the patient’s age using the recorded gestational age and birth time, and utilizes the following rules: 1) bilirubin result must exceed the pre-defined gestational age-specific MDLs, and 2) calculated gestational age is <35 weeks. Additionally, the SmartZone alert will not be triggered if there is an active phototherapy order. Once triggered, the alert will be visible for four hours to all caregivers who view the patient’s EMR. We compared the duration of time between verified bilirubin results and phototherapy orders before and after the implementation of the SmartZone alert.
Result
The SmartZone alert was implemented on 01/11/2022. Between 1/1/2021 - 1/11/2022, 95 preterm infants in the NICCU had neonatal and total bilirubin results, in which 19 met the criteria for the alert to be triggered, and 17 had phototherapy orders. Further analysis revealed that 12 orders were placed <24 hours, four orders were placed 24 - 72 hours, and one order was placed >72 hours after bilirubin results were verified. Between 1/12/2022 – 2/13/2022, 13 newly admitted preterm infants in the NICCU had neonatal and total bilirubin results, in which one triggered the alert, and phototherapy was ordered within 15 hours.
Conclusion
A SmartZone alert was implemented to encourage consistent and timely consideration of phototherapy for preterm infants <35 weeks with critical hyperbilirubinemia. The alert is functioning as intended. This alert will be continuously monitored to further optimize its functionality and utilization.</abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/ajcp/aqac126.049</doi><oa>free_for_read</oa></addata></record> |
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| issn | 0002-9173 1943-7722 |
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| source | Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Age Bilirubin Electronic medical records Gestational age Hyperbilirubinemia Infants Isomers Jaundice Light therapy Neonates Newborn babies Patients Phototherapy Premature babies |
| title | Implementation and Assessment of a SmartZone Alert to Notify Clinicians of Critical Hyperbilirubinemia in Preterm Infants Less Than 35 Weeks Gestation |
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