G236(P) Neonatal jaundice in the emergency department is not our problem to solve, or is it? Stepping outside the ED to improve patient experience and flow

Aims We observed an increasing number of well, jaundiced babies presenting to our hospital’s Paediatric Emergency Department (ED), despite a dedicated pathway and jaundice clinic accessible by direct midwife referral. Meanwhile the flow within our ED was affected, and patient safety and experience were compromised as reflected by a complaint and significant incident. By working with the multidisciplinary teams (MDTs) outside the ED to improve use of Jaundice Clinic pathway, our aim was to make a sustainable reduction in presentations to the ED, and improve safety and patient experience. Methods A retrospective analysis of ED attendances for 2018, was compared with data from the previous two years. Focus groups were held with six key stakeholders: postnatal midwives, community midwives, neonatal nurses, neonatal doctors and paediatric ED doctors, and obstetric governance lead. Information was gathered mapping the progression from birth, and storyboards showed patient experience. Results Previous audit data showed our dedicated jaundice clinic (established in 2017), had led to a reduction of well jaundiced babies presenting to ED from 288 babies (2016) to 111 (2017). However, in 2019, 154 babies were seen, of which 64% were referred by midwives. 60% of these newborns spent over 3 hours in ED. Nearly all could have gone straight to the neonatal unit, only 12% had clinical reasons to be seen by doctors in ED, and none required admission. We ran MDT focus groups to facilitate better understanding of each team’s current practice and barriers, e.g. inaccessible/broken transcutaneous bilirubinometers. The discussions highlighted the subsequent negative effect on patient safety and experience and the impact on capacity and ED flow. The identified barriers were reviewed, and solutions developed in discussion with all stakeholders. Resulting in creation of an improved pathway with new proforma and new community clinic. An online quiz was designed for training stakeholders. Conclusion To reduce well jaundiced babies presenting to ED, we needed to step out of our ED comfort zone and engage with the relevant MDTs involved. In the process, new understanding and relationships were made which will help to identify and mitigate issues earlier to ensure ongoing sustainability of this pathway.