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Pediatrics. 2017 Oct;140(4). pii: e20164310. doi: 10.1542/peds.2016-4310. Epub 2017 Sep 7.

Clinical Pathway Produces Sustained Improvement in Acute Gastroenteritis Care.

Author information

1
Department of Pediatrics, University of Washington, Seattle, Washington; and lori.rutman@seattlechildrens.org.
2
Division of Pediatric Emergency Medicine, Seattle Children's Hospital, Seattle, Washington.
3
Department of Pediatrics, University of Washington, Seattle, Washington; and.

Abstract

BACKGROUND AND OBJECTIVES:

Despite widespread use of the rotavirus vaccine in the last decade, dehydrating illnesses impact almost 2 billion children worldwide annually. Evidence supports oral rehydration therapy as a first-line treatment of mild to moderate dehydration. Ondansetron has proven to be a safe and effective adjunct in children with vomiting. We implemented a clinical pathway in our pediatric emergency department (ED) in January 2005 to improve care for this common condition. Our objective in this study was to determine the long-term impact of the pathway for acute gastroenteritis (AGE) on the proportion of patients receiving intravenous (IV) fluids and ED length of stay (LOS) for discharged patients.

METHODS:

Cases were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. We used statistical process control to analyze process and outcome measures for 2 years before and 10 years after pathway implementation.

RESULTS:

We included 30 519 patients. We found special cause variation with a downward shift in patients receiving IV fluids after initiation of the pathway and later with addition of ondansetron to the pathway from 48% to 26%. Mean ED LOS for discharged patients with AGE decreased from 247 to 172 minutes. These improvements were sustained over time.

CONCLUSIONS:

Implementation of a clinical pathway emphasizing oral rehydration therapy and ondansetron for children with AGE led to decreased IV fluid use and LOS in a pediatric ED. Improvements were sustained over a 10-year period. Our results suggest that quality-improvement interventions for AGE can have long-term impacts on care delivery.

PMID:
28882877
DOI:
10.1542/peds.2016-4310
[Indexed for MEDLINE]
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