Objectives Jaundice affects 60% of term neonates¹ and untreated hyperbilirubinaemia can cause kernicterus with subsequent brain damage. Current inpatient treatment of jaundice has multiple drawbacks for families and NHS hospitals. The aim was to establish safe home phototherapy, facilitate patient flow and reduce hospital inpatient bed days through creation of a clear pathway for the management of jaundiced neonates within the local region. Methods Well neonates with physiological jaundice between 2 and 14 days of life were included, and their parents educated about home phototherapy using BiliCocoon®(NeoMedLight, France). Families were provided with red flag advice and contact information for Neonatal Community Outreach (NCOT) and Paediatric Virtual Ward (PVW) teams as appropriate. Babies with suspected sepsis, or bilirubin above exchange level were excluded. Daily home visits were arranged to assess baby and check serum bilirubin (SBR) levels, with decision by NCOT/PVW on further management. Qualitative feedback was obtained from families to ensure positive experiences and allow the teams to reflect on care provision. The data and pathway information were disseminated at Trust and departmental level, through teaching, safety and governance meetings. Results Between June and September 2023 a total of 25 babies were cared for at home, saving 43 hospital bed days and over £15,600. There were two hospital re-admissions: One had reduced urine output and required feeding support, and the other was found to be febrile and received intravenous antibiotics. No babies were re-admitted with jaundice-related problems. Themes that emerged from the questionnaires include improved parental mental health, access to family network, quieter home environment, effective sleep, and partners having the opportunity to bond with baby. Additionally, the BiliCocoon® was felt to provide more consistent treatment as babies could be fed and comforted within the light-emitting diode blanket, supporting breast feeding better than traditional overhead light phototherapy. Usual maternal postnatal care was maintained as midwives could visit the family home, and cost savings included car parking, care of other children, and food for parents. Conclusion Our innovative, multi-professional pathway has provided safe and effective phototherapy at home, with prompt recognition and intervention for babies with additional diagnoses. At a time when NHS resources and ward capacities are stretched, we are working and communicating in a multi-disciplinary fashion to provide excellent holistic care to these babies and their families. Our pathway has helped to release inpatient beds for acutely unwell patients, supporting the NHS England Long-Term plan² to reduce demand on NHS secondary services. References NICE (2016) Jaundice in newborn babies under 28 days. National Institute of Health and Care Excellence. http://www.nice.org.uk (last accessed on 28 September 2023). NHS England (2019). The NHS Long Term Plan. Available at: www.longtermplan.nhs.uk/publication/nhs-long-term-plan (last accessed on 28 September 2023).
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Harris et al. (2024) studied this question.