Bilicurves: Using Information Technology to Improve the Management of Neonatal Hyperbilirubinemia
Bilicurves: Using Information Technology to Improve the Management of Neonatal Hyperbilirubinemia
We will use information technology to integrate the 2004 American Academy of Pediatrics
 guidelines for management of neonatal hyperbilirubinemia with laboratory reporting of newborn
 bilirubin test results to improve physician adherence to the guidelines and quality of care.
In 2004, the American Academy of Pediatrics disseminated clinical practice guidelines for the
 management of neonatal hyperbilirubinemia. Using the infant's age in hours, serum bilirubin
 levels are applied to hour-specific nomograms to assess risk of developing significant
 hyperbilirubinemia as well as the necessity for treatment. Prior guidelines did not include
 nomograms for either. A systems approach to managing neonatal hyperbilirubinemia, including
 use of the nomograms, has been shown to improve outcomes and patient safety.

 Despite the existence of these guidelines, decision support does not exist within MGH
 clinical information systems for managing neonatal hyperbilirubinemia. We propose to create
 BiliCurves, an application that integrates perinatal information from the obstetrical health
 record with that of the newborn's, providing seamless reporting of neonatal bilirubin results
 in the context of the practice guidelines and relevant obstetrical data. BiliCurves will
 graphically superimpose bilirubin results onto hour-specific guideline nomograms that
 providers can view when viewing bilirubin results. We propose to randomize BiliCurves access
 to pediatric providers, and study its effects on management of hyperbilirubinemia both during
 birth hospitalization as well as in the outpatient setting after discharge. We hypothesize
 infants treated by physicians with BiliCurves access will receive birth hospitalization
 phototherapy at a higher rate and readmission for hyperbilirubinemia at a lower rate than
 that of the control group. We also hypothesize that physicians with BiliCurves access will
 report greater ease and confidence in nomogram use and providing evidence-based care as
 BiliCurves obviates the provider having to have access to paper based versions of the
 nomogram (usual care) as well decreases potential errors in plotting test results on the
 nomograms.
Inclusion Criteria:

 -  Providers who care for infants in the newborn nursery.

 -  All newborns in the newborn nursery that are 35 weeks or more weeks of gestation will
 be study eligible.

 Exclusion Criteria:

 -  Infants less than 35 weeks gestation.