Implementation and assessment of an electronic clinical decision support tool to notify clinicians of critical hyperbilirubinemia in preterm neonates less than 35 weeks' gestation

Yi Xiao; Mandy Palmucc; Lance Carlin; Catherine Lee; Maurice R G O'Gorman; Srikumar Nair; Leah Yieh; Edward Ki-Yun Leung

doi:10.1093/ajcp/aqad112

Implementation and assessment of an electronic clinical decision support tool to notify clinicians of critical hyperbilirubinemia in preterm neonates less than 35 weeks' gestation

Am J Clin Pathol. 2024 Jan 4;161(1):83-88. doi: 10.1093/ajcp/aqad112.

Authors

Yi Xiao¹, Mandy Palmucc², Lance Carlin², Catherine Lee¹, Maurice R G O'Gorman^{1

3}, Srikumar Nair^{4

5}, Leah Yieh^{4

5}, Edward Ki-Yun Leung^{1

3}

Affiliations

¹ Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA.
² Clinical Information Services, Children's Hospital of Los Angeles, Los Angeles, CA.
³ Department of Pathology, University of Southern California, Los Angeles, CA.
⁴ Department of Pediatrics, Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital of Los Angeles, Los Angeles, CA.
⁵ Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.

PMID: 37698998
DOI: 10.1093/ajcp/aqad112

Abstract

Objectives: Critical hyperbilirubinemia in preterm neonates, a condition requiring greater attention, is treated with phototherapy or exchange transfusion when bilirubin results exceed gestational age and age-specific medical decision levels (MDLs) to prevent bilirubin-induced neurologic damage. Conventional evaluation involves multiple manual steps and is poised to inconsistencies and delays.

Methods: We designed and implemented an electronic clinical decision support (CDS) tool to identify and alert neonatal intensive care unit clinicians of critical hyperbilirubinemia with a SmartZone alert. We evaluated the performance of our manual evaluation workflow, the accuracy of the electronic CDS tool, and the outcome of the electronic CDS tool to reduce the time to place orders for interventions.

Results: Among the 22 patients who met the criteria to have phototherapy ordered before implementing the electronic CDS tool, 20 (90%) had phototherapy ordered. Fourteen (70%) phototherapy orders were placed less than 24 hours, 4 phototherapy orders were placed 24 to 72 hours, and 2 orders were placed more than 72 hours after bilirubin results exceeded the corresponding MDLs. Among the 15 patients who met the criteria to have phototherapy ordered after implementing the electronic CDS tool, all (100%) received phototherapy orders, with 14 (93%) placed less than 24 hours and 1 order placed less than 48 hours. The electronic CDS tool identified all eligible patients correctly. The proportion of phototherapy ordered less than 24 hours increased from 70% to 93% after the implementation of the electronic CDS tool.

Conclusions: The electronic CDS tool promoted more appropriate and timely intervention orders to manage critical hyperbilirubinemia in preterm neonates.

Keywords: SmartZone alert; electronic clinical decision support tool; preterm neonate.

MeSH terms

Bilirubin
Decision Support Systems, Clinical*
Female
Gestational Age
Humans
Hyperbilirubinemia, Neonatal* / therapy
Infant, Newborn
Phototherapy / methods
Pregnancy

Substances

Bilirubin