Transcutaneous bilirubinometry linked to decreased serum testing and costs [Pediatrics Classics Series]

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1. In a 2 year study period, researchers observed a significant decrease in the number of infants undergoing bilirubin serum testing after introduction of a transcutaneous bilirubinometer in one hospital’s newborn nursery.

2. The use of the transcutaneous instrument decreased hospital costs by $1625 each year when compared to serum bilirubin measurements.

Original Date of Publication: April 1997

Study Rundown: At the time of this study, one of the most commonly completed laboratory tests in the newborn nursery was the serum bilirubin level, second only to other routine genetic and metabolic screening tests. Researchers proposed that the use of a transcutaneous instrument for bilirubin measurements would be an effective way to decrease unnecessary serum bilirubin testing as well as reduce costs in the nursery setting. As the use of a transcutaneous bilirubinometer (TcB) was integrated into the nursery work environment, researchers observed a significant decrease in the number of serum bilirubin measurements completed. In addition, significantly less low serum bilirubin (< 10 mg/dL) measurements were obtained over the course of the study, indicating a potential decrease in unnecessary serum tests secondary to TcB use. TcB monitor use was also associated with an estimated decrease in annual hospital expenses secondary to bilirubin monitoring of about $1625. This study is limited in its lack of a control group, possible lack of generalizability due to only one nursery investigated, and complications with the practicality of the device as a TcB device is expensive, requires calibration to ensure accuracy, and may be affected by skin pigmentation. However, TcB use for monitoring the bilirubin levels of healthy infants could reduce the need for unnecessary invasive testing in addition to lowering overall costs and may be most appropriate in the outpatient setting. Today, this device is commonly used as its validity and reliability has been reaffirmed in numerous studies.

Click to read the study in Pediatrics

In-Depth [prospective cohort study]: The relationship between TcB and serum bilirubin measurements was assessed prior to use in the clinical setting. On November 1, 1990, the TcB meter was introduced for regular use in the William Beaumont Hospital Department of Pediatrics newborn nursery. The number of serum bilirubin measurements along with the estimated total costs for performing the tests was calculated for newborns in the nursery from July 1990 to December 1992. Costs included salary for laboratory staff, supply costs, and time required for the procedure.  Information from a total of 12 625 infant admissions were included in the analysis. Data from July 1990 to December 1990 admissions were considered “pre-jaundice meter” as hospital staff adjusted to TcB use. A 40% decrease in infants requiring at least 1 serum bilirubin test and a 56% decrease in those requiring at least 2 (p < 0.0001) were seen by study completion. Over the course of the study, bilirubin levels less than 10 mg/dL decreased significantly, starting at 46% of readings progressing to 27% of readings at the study conclusion (p < 0.0001). When the costs related to serum and transcutaneous bilirubin measurements were calculated, it was found that nearly $1625 total per year for a cohort of 12 625 infants would be saved through regular TcB use.

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Image: PD