Yeovil Hospital neonatal nurses reduce diagnosis times for jaundice in newborns

Senior sister Beth Hawken and staff nurse Eleonora Forbes at Yeovil Hospital set about investigating readmissions to hospital of small babies with jaundice. The project was part of Somerset NHS Foundation Trust’s chief nurse research fellowship that ran last year. The findings resulted in a major change to the way test results are processed.

Beth explains: “Eleonora and I reviewed five different case studies of babies who had come back into hospital onto our postnatal ward. We studied every aspect of their care pathway, from the moment they were readmitted to hospital and the time they were reviewed by a doctor, to when their bloods were taken. We also looked at the time it took for their bloods to get to the lab, how long the processing took, and the timeframe that a clinician reacted to the result…all the way through to the baby’s discharge from hospital.

“We wanted to find out whether any part of this process seemed to cause a delay for every baby we care for, and if there was a way that we could improve it.”

Eleonora adds: “After we captured the results of five case study babies, we began a literature review, which also involved speaking to other people and groups interested in this type of work.

“For each baby we looked at whether there was a delay and what caused it, and alongside this we checked our literature review to see how jaundice was being managed in other areas of the country and even worldwide.

“By doing this, we found out that one of the major reasons for a delay in treatment for jaundice was that the blood sample journey took up to seven hours, from when it was first taken, to its transportation to the laboratory, analysing process, checking of the result and the beginning of phototherapy treatment – it felt a bit too long and we were sure that it could be reduced.”

Eleonora explains how their findings led to the diagnosis time for jaundice reducing from seven hours to just two to three minutes: “One of the main areas of delay found was the process of analysing bloods. From there, we found out we were already using this type of blood gas analysing equipment on our maternity unit and one of the results shows the level of bilirubin in the blood – which is the main cause of jaundice. The machine wasn’t calibrated for analysing the bilirubin level in small neonatal babies though.

“From our earlier literature search, we found that some units did use this type of machine in neonatal care, so we contacted our biochemist consultant and asked whether we could do this with our machine.

“This is a real game-changer in the care of neonatal babies as their treatment is not only much more efficient, but they’re not jaundiced for so long, meaning they are less likely to experience any complications.

“Sometimes if the jaundice gets too high, we aren’t able to treat it at YDH so the baby has to be transferred to Musgrove Park Hospital, or even Bristol Children’s Hospital, so starting it early can only be a good thing for everyone.”