Journal ArticleDOI
Applying the “10 Simple Rules” of the Institute of Medicine to Management of Hyperbilirubinemia in Newborns
R. Heather Palmer,Mark S. Clanton,Sudhakar Ezhuthachan,Christine Newman,Jeffrey Maisels,Paul E. Plsek,Susanne Salem-Schatz +6 more
TLDR
By describing a practical application of the ideas about complex adaptive systems to newborn care, the report aims to help pediatricians prepare to lead in this field and give physicians insights to develop and modify health care systems.Abstract:
Arecent Institute of Medicine (IOM) report describes a chasm in health care quality that we must cross for patients to receive better care in the 21st century. The report calls for a “systems approach,” drawing on the rapid evolution of knowledge about complex adaptive systems.1 Understanding how complex adaptive systems work can give physicians insights to develop and modify health care systems. By describing a practical application of the ideas about complex adaptive systems to newborn care, we aim to help pediatricians prepare to lead in this field.
A complex adaptive system is a collection of individual agents who have the freedom to act, but because the agents are interconnected, action by any agent changes the context for other agents in the system. One familiar example is the buyers in a stock market. In the last century, it was usual to see organizations as mechanical systems: in mechanical systems, if we know what each part of a system does, we can predict perfectly how the whole will respond in a given situation. This is obviously not true of the stock market. A complex adaptive system may display sudden unpredictable shifts in behavior caused by interactions among agents. An essential first step in improving the US health care system is to recognize that its member organizations and individuals, with sublevels nested within and interconnected to each other, make up a complex adaptive system.
One of the key attributes of a complex adaptive system is that orderly behavior can emerge among many agents who are acting independently but who share a common drive. For instance, ants, driven to survive, create intricate buildings and foraging systems without any planning by a chief executive ant. So do humans. The citizens of New York City share a drive to eat; with no single individual …read more
Citations
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Journal ArticleDOI
Response to 'The appropriation of complexity theory in health care'
TL;DR: Paley suggests that in the article on complexity, leadership and management, the authors misinterpreted the notion of the self-organizing system to mean that bottom-up approaches to organizational strategy and development should replace top-down ones.
Journal ArticleDOI
Delayed Pediatric Office Follow-up of Newborns After Birth Hospitalization
Jochen Profit,Jochen Profit,Alva J. Cambric-Hargrove,Kay O. Tittle,Kenneth Pietz,Kenneth Pietz,Ann R. Stark +6 more
TL;DR: Understanding reasons for delayed follow-up and providing guidance for jaundice management may promote a safer first week of life among a large group of urban and suburban pediatricians.
Journal ArticleDOI
Risk management of severe neonatal hyperbilirubinemia to prevent kernicterus.
TL;DR: This approach for risk management of severe neonatal hyperbilirubinemia to prevent kernicterus includes management of certain high-risk clinical situations, identification of systems failure, and suggestions for implementation strategies to enhance patient safety.
Journal ArticleDOI
Closing the gap between guidelines and practice: ensuring safe and healthy beginnings.
Carole Lannon,Ann R. Stark +1 more
TL;DR: The revised American Academy of Pediatrics’ guideline for the management of hyperbilirubinemia in infants ≥35 weeks’ gestation, published in the July issue, provides a contemporary evidence-based approach to a condition that affects the majority of otherwise healthy newborns.
Journal ArticleDOI
Systems changes to prevent severe hyperbilirubinemia and promote breastfeeding: pilot approaches.
Ann R. Stark,Carole Lannon +1 more
TL;DR: The American Academy of Pediatrics Safe and Healthy Beginnings Initiative, a pilot quality improvement project, will target newborn nurseries, primary care practices and coordination between these sites using a systems-based approach to facilitate implementation of the 2004 guideline for management of hyperbilirubinemia.
References
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Journal ArticleDOI
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Predictive Ability of a Predischarge Hour-specific Serum Bilirubin for Subsequent Significant Hyperbilirubinemia in Healthy Term and Near-term Newborns
TL;DR: An hour-specific predischarge serum bilirubin measurement before hospital discharge can predict which newborn is at high, intermediate or low risk for developing clinically significant hyperbilirubinemia (specifically defined as TSB levels ≥95th percentile for age in hours).
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Neonatology : pathophysiology and management of the newborn
TL;DR: The Fetal PATIENT TRANSITION and STABILIZATION, the low birthing weight infant and the new born infant pharmaceuticals are considered.
Journal ArticleDOI
Practice Parameter: Management of Hyperbilirubinemia in the Healthy Term Newborn
TL;DR: Most studies have failed to substantiate significant associations between a specific level of total serum bilirubin (TSB) during nonhemolytic hyperbilirubinemia in term newborns and subsequent IQ or serious neurologic abnormality (including hearing impairment).