Development of a Web-based decision support tool to increase use of neonatal hyperbilirubinemia guidelines

Jt Comm J Qual Patient Saf. 2009 May;35(5):256-62. doi: 10.1016/s1553-7250(09)35035-7.


Background: The 2004 American Academy of Pediatrics (AAP) guidelines for management of hyperbilirubinemia in the newborn infant at > or =35 weeks of gestation recommend that clinicians systematically asses the risk of severe hyperbilirubinemia before hospital discharge. Using the guidelines requires access to the printed nomograms, calculation of the infant's age in hours, and manual plotting of total bilirubin results. The combination of a common clinical problem with the existence of guidelines for best practice is an ideal target for clinical informatics tools to help improve compliance. A Web-based clinical decision support tool was developed on the basis of a combination of published data and linear extrapolation to automate the hour-specific risk stratification nomogram and phototherapy nomogram.

Methods: After BiliTool, the clinical decision support tool that contained the AAP clinical guidelines, was made publicly available, Web-site usage was monitored. An online survey composed of 10 multiple-choice, Likert-scale, and yes-no questions was made available.

Results: The number of site visits has increased over time. Of the 469 respondents to the survey, 297 respondents considered themselves tool "users".

Discussion: Rapid uptake and high ratings for clinical utility confirm that Web-based clinical decision support tools are in high demand and may increase use of clinical guidelines. Given the risk of human error with manual age calculation and nomogram plotting, this tool may also decrease the likelihood of medical errors, particularly with integration into the electronic medical record. Concomitant release of Web-based decision support tools with clinical guidelines would optimize the guidelines' adoption and implementation. Also, the integration of BiliTool into the electronic medical record may serve as a model for integrating other Web-based clinical decision support tools.

MeSH terms

  • Decision Support Systems, Clinical / organization & administration*
  • Guidelines as Topic
  • Humans
  • Hyperbilirubinemia, Neonatal / therapy*
  • Infant
  • Infant, Newborn
  • Internet*
  • Neonatal Nursing / standards*
  • Program Development*
  • Software Design
  • User-Computer Interface