140 - Facilitating QI activities Globally through Digital Technology: Decreasing Severe Neonatal Hyperbilirubinemia

Poster Number: 140
Publication Number: 140.111

Indira Narayanan, Georgetown University Medical Center, Brookline, MA, United States; Ashura M. Bakari, Ghana Health Service, Kumasi, Ashanti, Ghana; Jeffery K. Arhin, N/A, Rotterdam, Zuid-Holland, Netherlands; Nancy A. Crowell, Georgetown University School of Nursing, Washington, DC, United States; Jayashree Ramasethu, Georgetown University School of Medicine, Washington, DC, United States

Background: Severe Neonatal Hyperbilirubinemia (SNH) is a major cause of neonatal mortality in Sub-Saharan Africa and can cause neurodevelopmental disability in survivors. Exchange transfusions (ET) to reduce high bilirubin levels are common in low/middle income countries (LMIC) due to late detection of jaundice. Mothers are often discharged from hospital < 24 hours after delivery. A Blended Learning Quality Improvement (QI) Program using digital technology (the in-country workshop was cancelled due to COVID 19 pandemic) was developed between Georgetown University (GU) and district hospitals in Ghana to improve quality of neonatal care (funded by GU Global Health Initiative); one component was to reduce SNH and ET.

Objective: To facilitate QI activity at a Ghana District Hospital (GDH) promoting early care seeking in mothers for neonatal jaundice so that phototherapy may be used to decrease SNH and ET.

Design/Methods: GU faculty used Zoom and WhatsApp platforms to work with GDH staff to facilitate formation of a QI team, implement interactive health education with videos by trained midwives for antenatal / post-partum mothers, initiate daily rounds by physicians in postnatal wards, promote community health nurses to call/visit mothers postnatally at home, and maintain data on pre-defined key outcome indicators. The goal was to reduce the proportion of inborn infants ≥ 34 weeks gestational age being brought to the neonatal unit with SNH (serum bilirubin levels ≥ 340umol/L or 20 mg/dL) by 15% within 3 months. The program was exempted from review by the GU IRB. Stat analysis: Chi- square; Fisher exact test.

Results: From Oct 2019 to Jan 2020, 14 (28%) of 50 discharged infants were readmitted with SNH and 7 (14%) received ET. Figure 1 shows the trend graph of infants admitted with SNH and ET each month after the initiation of the QI project in Jan 2020. Table 1 shows the decline in SNH and ET in the 3 months post intervention as well as a significant sustained decline for 16 months. There was a significant increase in infants being brought in for bilirubin levels < 255umol/L after the intervention.Conclusion(s): Despite internet connectivity problems, this digitally mediated QI project demonstrated success in reduction of SNH in a district hospital in a LMIC. Regular review of trend graphs, repeated facilitation, implemented through low-cost digital technology, are effective in promoting QI activities and can be applied regionally and globally. The increase in infants being brought in for mild jaundice points to the need for objective methods of determining bilirubin levels in the community.
Fig 1. Severe Neonatal Hyperbilirubinemia and Exchange Transfusions Pre- and Post-Intervention
Table 1. Pre- and Post Intervention Bilirubin Levels and Exchange Transfusion Rates