Implementation and Assessment of a SmartZone Alert to Notify Clinicians of Critical Hyperbilirubinemia in Preterm Infants Less Than 35 Weeks Gestation

Abstract Background Neonatal jaundice, also known as hyperbilirubinemia in term and preterm infants, is treated with phototherapy when bilirubin results exceed gestational age- age-specific medical decision levels (MDL) to prevent kernicterus bilirubin-induced neurological damage. During phototherapy, unconjugated converted water-soluble isomers that are excreted the urine. Presently, electronic record (EMR) at our hospital cannot use age stratify reference ranges thereby associated flags alerts would not be triggered, leading delays reviewing placing orders. The aim of this project replace current manual assessment process for a newly designed alert notify clinicians elevated infants (<35 weeks gestation) minimize prolonged We hypothesized SmartZone will encourage consistent timely consideration phototherapy. Method A alert, built Cerner command language Discern Expert rules, evaluates total or neonatal patients Newborn Infant Critical Care Unit (NICCU), calculates patient’s using recorded birth time, utilizes following rules: 1) result must pre-defined MDLs, 2) calculated <35 weeks. Additionally, triggered if there an active order. Once visible four hours all caregivers who view EMR. compared duration time between verified orders before after implementation alert. Result was implemented on 01/11/2022. Between 1/1/2021 - 1/11/2022, 95 NICCU had results, which 19 met criteria 17 Further analysis revealed 12 were placed <24 hours, 24 72 one order >72 verified. 1/12/2022 – 2/13/2022, 13 admitted ordered within 15 hours. Conclusion critical hyperbilirubinemia. functioning intended. This continuously monitored further optimize its functionality utilization.