580 - Evaluating Direct Admission as an Efficient Alternative to ED Admission for Neonatal Hyperbilirubinemia: A Community Hospital Experience

Publication Number: 2565.580

Sanjana Sachdeva, The Children's Hospital at Monmouth Medical Center, LONG BRANCH, NJ, United States; Narihan Osman, Monmouth medical center, Scotch plains, NJ, United States

Background: Admission for phototherapy due to neonatal hyperbilirubinemia is a frequent occurrence in every pediatric hospital. Employing Direct admission (DA) to the hospital for this diagnosis is common, but few studies exist to measure its perceived benefits or risks. A recent study in an academic, free-standing children's hospital noted that DA is a preferred alternative due to its shorter stay and reduced resource utilization.

Objective: To compare DA and emergency department (ED) admission for neonates requiring phototherapy due to hyperbilirubinemia, focusing on differences in time to care and resource utilization in a community hospital setting.

Design/Methods: We conducted a retrospective single-center chart review-based study of neonates born at ≥35 completed weeks’ gestation who were admitted to the hospital from home with a diagnosis of neonatal hyperbilirubinemia from 2023 to 2025.

Results: Of the 115 patients, three were excluded as they did not receive phototherapy during their hospital stay. 69.7% were admitted through the ED, while 30.3% were admitted through DA. Patients admitted through the ED had a greater mean Length of Stay. A significant difference was found in the time to start phototherapy. On average, patients admitted through the ED have 117 minutes longer time to phototherapy than those admitted directly. It was observed that admissions through the ED were more likely to receive an IV line and other laboratory tests than DA patients; however, these differences were not statistically significant.

Conclusion(s): DA for receiving phototherapy was associated with a quicker start of phototherapy compared to admission through the ED, with no significant increase in resource utilization. These findings suggest that DA is a practical and efficient option for stable neonates needing phototherapy in a Community hospital setting. Our study is significant because previous studies on DA have originated from larger, free-standing children’s hospitals. Limitations include the single-center, retrospective design and relatively small sample size, which may limit generalizability and the power to detect subgroup differences. The timing of bilirubin measurements and initiation of phototherapy was based on a chart review, which may introduce measurement bias. Future prospective studies could confirm these results and explore their impact on overall care and family experience. In addition, establishing a dedicated hospital pathway for direct admissions could simplify the process.