Implementation of a prolonged neonatal jaundice protocol supported by electronic software

Abstract

PurposeSeveral audits of clinical practice have confirmed that there is insignificant yield from screening of prolonged jaundice babies with a wide range of tests including thyroid function test (TFT) and full blood count (FBC). This paper aims to audit local practice based on a newly adopted rationalised protocol of selective screening with split bilirubin supplemented with other investigations based on clinical risk assessment.Design/methodology/approachThe paper uses a retrospective audit of 50 babies referred for prolonged jaundice to a large district hospital in South West England. The authors also designed an easy‐to‐use, user‐friendly software application as a quick aid for implementation of the prolonged jaundice protocol.FindingsThe overall annual incidence of prolonged jaundice was 2.2 per cent of all live births. 32 patients (64 per cent) had only split biliburin test according to the protocol. In total 16 patients (32 per cent) had 18 tests requested unnecessarily including seven liver function test (LFT), eight FBC, one each of glucose, TFT and serum electrolytes. No patient with any serious liver disease was missed.Practical implicationsAppropriate recommendations for optimising the implementation of the current protocol based on the available scientific evidence were introduced.Originality/valueAfter two years of implementation of the protocol, it has been found to be cost‐effective and safe. The electronic software provides a useful prompt in guiding the investigation of prolonged jaundice.