ED clinical care pathway sustains improvement in acute gastroenteritis

Reuters Health Information: ED clinical care pathway sustains improvement in acute gastroenteritis

ED clinical care pathway sustains improvement in acute gastroenteritis

Last Updated: 2017-09-07

By Reuters Staff

NEW YORK (Reuters Health) - A clinical care pathway implemented in the pediatric ED at Seattle Children's Hospital has produced sustained improvement in acute gastroenteritis (AGE) care, researchers report.

The clinical pathway, which emphasizes oral rehydration therapy (ORT) and ondansetron for children with AGE, led to decreased IV fluid use and time spent in the ED, improvements that have been sustained for 10 years, Dr. Lori Rutman and colleagues report online September 7 in Pediatrics.

Despite widespread use of rotavirus vaccine for the past decade, dehydrating illnesses continue to hit nearly 2 billion children worldwide each year and cause more than 700,000 deaths, the researchers note in their article. AGE-related dehydration is one of the most common problems of childhood.

A large body of evidence supports the use of ORT and ondansetron for treating mild to moderate dehydration, yet gaps in use remain, they point out.

To improve AGE care at their center, in 2005, Dr. Rutman and colleagues implemented an AGE clinical pathway, which included provider education on use of ORT and ondansetron in children with vomiting. They assessed the long-term impact of the pathway on IV fluid administration and length of ED stay, by analyzing data two years before and 10 years after implementation.

Data on more than 30,000 patients suggests a "downward shift" in the percentage of patients receiving IV fluids after initiation of the pathway, and later with addition of ondansetron to the pathway, from 48% to 26%.

In addition, average length of stay in the ED for discharged patients with AGE decreased from 247 minutes to 172 minutes following the initiative. "These improvements were sustained over time," the authors report.

"Our results suggest that quality improvement interventions for AGE can have long-term impacts on care delivery," they conclude. They say contextual factors, such as the culture of an institution and support from leadership for such interventions are "important considerations for implementation success and long-term sustainability."

The study had no commercial funding and the authors have disclosed no conflicts of interest.

SOURCE: http://bit.ly/2xd8IEi

Pediatrics 2017.

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