154 - Development and Implementation of Evidence-Based Newborn Medicine Clinical Pathways in a Community Hospital Setting

Publication Number: 3148.154

Laura Cardello, Boston Children's Hospital, Norwell, MA, United States; Caitlin Kent, Boston Children's Hospital, Norfolk, MA, United States; Megan Trexler, Boston Children's Hospital, Walpole, MA, United States; John J. Porter, Boston Children's Hospital, Boston, MA, United States; Melissa Sundberg, Boston Children's Hospital, Boston, MA, United States

Background: Clinical pathways standardize care, reduce practice variation, and improve quality. While most pediatric pathways are developed in academic centers, their impact in community hospital settings-where a substantial proportion of newborns receive care-remains poorly characterized. Furthermore, patient-level quality metrics are often undefined in these environments. Developing and implementing measurable, evidence-based pathways offer a framework for quality improvement in community hospitals.

Objective: To develop and implement evidence-based clinical pathways for common newborn conditions in a level I community hospital nursery, with the goal of reducing practice variability and improving patient outcomes.

Design/Methods: The project was conducted in a community hospital with approximately 3,500 annual births. Three clinical pathways-hypothermia, hyperbilirubinemia, and newborn sepsis-were developed using current evidence and input from local clinical experts. Over six years, multidisciplinary teams-including physicians, nurses, and IT staff-collaborated in pathway design and iterative refinement through Plan-Do-Study-Act cycles. Pre-implementation data were collected over 24 months, followed by prospective monthly data collection post-implementation. Eligible patients were newborns ≥35 weeks' gestation delivered in-hospital.

Results: Implementation of the pathways was associated with significant improvements in care metrics. Hyperbilirubinemia readmissions decreased from 0.8% to 0.3% (Fig.1,2); empiric antibiotic use for suspected sepsis declined from 100% to 20% following adoption of a sepsis risk calculator (Fig. 3); and NICU admissions for hypothermia decreased from 0.76% to 0.09% with implementation of a pathway. No missed cases of sepsis or delays in management for hypothermia or hyperbilirubinemia were identified.

Conclusion(s): Implementation of evidence-based newborn clinical pathways in a community hospital setting reduced unnecessary interventions, improved patient outcomes, and maintained safety. This structured, multidisciplinary approach is feasible and may be generalizable to other community hospital nurseries seeking to standardize newborn care.

Figure 1
Percentage of newborns with readmission for hyperbilirubinemia after development of a clinical pathway.

Figure 2
Clinical Pathway Developed for Newborn Evaluation of Hyperbilirubinemia

Figure 3
Percentage of infants born to mothers with fever/chorioamnionitis who received antibiotics after birth in the newborn nursery.