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G38(P) The challenge of change
  1. A Nosherwan,
  2. M Mahony,
  3. M Floyd,
  4. J Twomey
  1. Paediatrics, Mid Western Regional Hospital, Limerick, Ireland

Abstract

Introduction Gastroenteritis poses a major burden for health services. National Accident Emergency Medical guidelines for acute gastroenetritis in children provide a clear, safe guideline to instruct assessment and treatment of acute gastroenteritis highlighting the non-inferiority/value of enteral rehydration for acute gastroenteritis.

Aims To systematically review clinical practice against the national guidelines for management of gastroenteritis in children under 5 years of age, to implement the necessary changes and to examine the change in practice followed by implementation program for the clinical guidelines.

Method Initially retrospective audit was performed of patients presenting with mild and moderate dehydration due to acute gastroenteritis, age between 6 months and 5 years from 1st July – 31st august 2012. Parameters measured were hydration status at presentation, mode of rehydration and hospital admission or discharge. The results were analysed against the national guidelines and the desired changes were implemented by targeted staff education. The clinical practice was reevaluated to study the effects of the implemented changes for the similar parameters from 1st February to 31 March 2013.

Results During the retrospective study, there were 76 presentations recorded with mild (75%) and moderate (25%) dehydration. Enteral and intravenous rehydration was used in 46% (n = 33) and 35% (n = 27) respectively. 60% (n = 43) cases were admitted. Following implementation of the guidelines, 88 episodes were studied prospectively, 73% were mild and 27% were moderately dehydrated. The enteral rehydration was successfully offered to 84% (n = 74) patients and intravenous rehydration in 15% (n=14). Admission rate was 29% (n = 26). On comparing the results between pre and post implementation phases there was a significant reduction in the use of intravenous therapy (p = 0.006) and hospital admission (p = 0.001).

Conclusion Systematic review of the clinical practice and targeted staff education to implement the change improved the management of acute gastroenteritis in the emergency department and thus helped establish the best practice in a regional setting.

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