- Design
- Convergent mixed-methods analysis within a national quality improvement collaborative
- Population
- Site leaders and inpatient phototherapy data from US hospitals in the collaborative
- Primary outcome
- Reasons for and change in subthreshold phototherapy
- Effect
- Six themes for use and six for barriers; no QI intervention linked to a significant reduction
A US quality collaborative tried to reduce phototherapy started below guideline thresholds. Subthreshold use was high at baseline and stayed high. This study asked site leaders why, and tested which changes were linked to improvement.
The reasons were lack of timely outpatient follow-up, fear of readmission or a longer stay, and clinician habit. None of the measured interventions was associated with a significant reduction.
The lesson is that the decision is driven by anxiety about what happens after discharge. In settings where follow-up is uncertain, including much of India, the tension is real; a clear follow-up plan is the alternative to treating early.
- Clinicians cited poor outpatient follow-up, fear of readmission and habit.
- Weekend bilirubin follow-up did not reduce subthreshold use.
- Home phototherapy access did not reduce it either.
- Clinical pathways discouraging it had no measurable effect.
Why it matters
Phototherapy below threshold separates mother and baby and prolongs stays, and standard quality improvement tools did not shift it.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for paediatrics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free