142 - Evaluating the Impact of an evidence based bilirubin discharge bundle on readmission rate of newborns due to indirect hyperbilirubinemia

Publication Number: 3136.142

Adaora G. Madubuko, Rutgers New Jersey Medical School, Livingston, NJ, United States; Sidney K. Chu, Rutgers New Jersey Medical School, New Brunswick, NJ, United States; Harpreet Kaur, Rutgers New Jersey Medical School, North Brunswick, NJ, United States; Nedi Okwor, Rutgers, Robert Wood Johnson Medical School, Newark, NJ, United States; Aleena Dar, Rutgers New Jersey Medical School, Newark, NJ, United States; Helen N. Nguyen, Rutgers New Jersey Medical School, Newark, NJ, United States; Robert Abbott, Rutgers New Jersey Medical School, Newark, NJ, United States

Background: Severe neonatal hyperbilirubinemia remains a preventable cause of morbidity and readmission. Despite AAP recommendations for universal bilirubin screening and early follow-up, discharge and documentation practices vary widely. To improve discharge standardization and care transitions, we implemented an evidence-based Bilirubin Discharge Bundle (BDB) integrated into the electronic medical record (Epic) to align discharge workflows with the 2022 AAP hyperbilirubinemia guidelines.

Objective: To determine whether BDB implementation reduces 7-day neonatal readmissions for indirect hyperbilirubinemia and to identify factors influencing effective discharge outcomes.

Design/Methods: A retrospective chart review was conducted at University Hospital (Newark, NJ) comparing pre-implementation (Jan 2017-Dec 2022) and post-implementation (Oct 2023-Dec 2024) data among newborns 35-42 weeks' gestation.
The BDB included documentation of bilirubin levels, neurotoxicity risk factors, AAP-based phototherapy thresholds, and structured follow-up planning. Providers were trained in BDB use; compliance and accuracy were audited monthly.
Statistical analyses included χ² for categorical comparisons, logistic regression for readmission predictors, and mixed-model ANOVA for clinical factor effects.

Results: At baseline, 8,458 births yielded 567 readmissions (6.7%), 82% due to hyperbilirubinemia. After BDB implementation (1,803 births), 58 readmissions (3.4%) occurred, reflecting a 3.3% absolute reduction (p <.00001).
BDB utilization rose from < 1% to 93.6%, with 65% accurate completion.
Appropriate follow-up was independently associated with an 85% reduction in readmission odds (OR=0.15, p=.021). Demographic shifts (e.g., increased cesarean deliveries, Spanish-speaking mothers) did not alter outcomes.
Focus group feedback favored the prose BDB format for ease of use and workflow integration. No adverse balancing measures were identified.

Conclusion(s): Implementation of an EMR-integrated, evidence-based discharge bundle significantly reduced early neonatal readmissions due to indirect hyperbilirubinemia. High provider adoption demonstrated strong feasibility, though documentation fidelity limited maximal impact. Sustained improvement will require ongoing provider training, feedback loops, and integration of family-centered follow-up to ensure consistent and equitable discharge practices.

Key Clinical and Implementation Outcomes With and Without Bilirubin Discharge Bundle (BDB)
BDB Pre and Post Implementation

Readmission Rate Vs Overall Bilirubin Discharge Bundle Use Vs Appropriate BDB Use
BDB Use Vs Appropriatness of Use Vs Readmission Rates

Monthly Trends in BDB Appropriate Utilization and BDB Type
Montly BDB Utilization