1065 Developing a teaching program to support health visitors in the management of prolonged jaundice

Abstract

<h3>Background</h3> Prolonged jaundice is very common in newborns. Investigation of the underlying cause in a timely manner is essential to rule out pathological causes, as one potential underlying cause (biliary atresia) requires prompt diagnosis and management. An audit of the prolonged jaundice clinic at St Mary’s Hospital London identified that not all babies with prolonged jaundice were being appropriately referred to clinic. It is essential that all health care professionals seeing these patients are aware of the correct referral pathways so they are seen in a timely manner in the appropriate setting. <h3>Objectives</h3> A quality improvement project was undertaken with health visitors which aimed to: Identify any barriers relating to referral to prolonged jaundice clinic Identify knowledge of guidelines relating to management of prolonged jaundice Improve understanding of referral pathways and the correct timing Improve communication between primary and secondary child healthcare delivery services <h3>Methods</h3> Connecting Care for Children (CC4C) is an integrated care model focused on primary and secondary care collaboration across North West London. Through established networks, we conducted semi-structured interviews with health visitors to review knowledge of prolonged jaundice and referral pathways. These identified barriers to referral, variation in practice, and a desire for further teaching on the topic. Many did not have access to recent guidelines or referral pathways. We created an information bundle and teaching session with information about prolonged neonatal jaundice, its treatment and investigation, and resources for parents/carers. We also focused on current referral pathways and the reasons for urgent vs non-urgent referral. Case studies facilitated further review of practice and barriers to referral. Health visitors were asked to complete pre and post-session surveys relating to prolonged jaundice, and to answer case studies one week following the session. <h3>Results</h3> Surveys and scenario discussions identified uncertainty regarding age for referral, unease with referring to the clinic instead of ED, and that the amount of visible jaundice was being used as criteria for referral. There was good understanding of red flag symptoms. Most health visitors were not aware of current referral pathways and felt only ‘somewhat confident’ with management. Two participants completed follow-up surveys which showed improved confidence, correct knowledge of age for referral, but continued uncertainty regarding referral to ED instead of clinic and use of the extent of visible jaundice as a marker for urgency of referral. Health visitors felt that the prolonged jaundice information pack was useful for their consultations and felt it was appropriate for parents/carers. <h3>Conclusions</h3> There are significant variations in practice between health visitors with management and referral of prolonged jaundice for investigation, and many felt that information was not easily available. It is inconclusive if our teaching resulted in long-term improvements due to low response rates, but it is evident that there is short-term improvement in when to refer, and that there remains uncertainty of the mode of referral. The CC4C network provides a unique model to facilitate teaching and communication, and it is clear that this would be of benefit for babies with prolonged jaundice.