High-Value Care in Pediatrics: Things We Do for No Reason

Dr. Tantoco Dr. Tchou began by defining value as an equation, with value equaling the sum of outcomes, patient experience, and equity, divided by the sum of cost and input. He emphasized that child health care spending has greatly increased in the U.S. and can result in inefficient systems, burnout, and preventable harm.  He applied the value equation to a case of a five-day-old, healthy, term newborn with elevated bilirubin in the high-risk zone. An outpatient pediatrician requested hospital admission for this infant with a bilirubin of 19.2 on a Friday night for fear of the bilirubin increasing with the need for phototherapy prior to Monday. This ensued a discussion with the audience on how to best care for this infant. Dr. Tchou discussed that kernicterus usually occurs when total serum bilirubin is over 40 mg/dL with more than two neurotoxicity risk factors. In addition, phototherapy may increase the risk of cancers and seizures. Phototherapy may also decrease the rate of breastfeeding and can cause stress and anxiety to parents and caregivers. Hospitalization for phototherapy also results in medical and non-medical costs for the families. He highlighted that one should not initiate phototherapy in term or late-term well-appearing infants who have bilirubin levels below the American Academy of Pediatrics guideline threshold for treatment. This recommendation is one of those in “Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value,” ...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Neonatal Medicine Pediatrics SHM Converge Source Type: research