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M. Lakhanpaul1, T.J. Stephenson1, R. MacFaul2, U. Werneke3, P. Hemingway1.

1 Child Health, University of Nottingham; 2 Pinderfields General Hospital; 3 Maudsley Hospital, London

Introduction: Health professionals often spend a great deal of time developing new guidelines but little attention is given to the process of implementation.

Aim: To evaluate the implementation of an evidence-based guideline on the management of the child presenting with an acute breathing difficulty.

Method: An evidence based guideline was developed and a variety of strategies were employed to help implement the guideline such as small teaching sessions, workshops and dissemination of written material. In addition, the resulting guideline was implemented as an algorithm in the emergency department. Data on investigation, treatment, and cost of care were collected during four month periods before and after implementation.

Results: Data was analysed on 979 children before and 442 children after the implementation. There was a significant increase in the number of children having oxygen saturations and respiratory rate observed (p less than 0.001 and p=0.001). A significant decrease in the number of urea and electrolytes, c-reactive protein, blood culture and chest x ray (p=0.002, p=0.002, p=0.001, p less than 0.001 respectively) was found. There was a significant increase in the number of children with croup treated with oral steroids (p<0.001). Significantly less nebulisers (p=0.013) and significantly more spacers (p=0.001 exact) were used in the treatment of children with asthma. More children were admitted to hospital post implementation (p=0.04) but there was significantly less children re-attending the department within 24 hours (p=0.001). The total cost of attending to a child fell significantly from £78.33 to £74.73 (p is less than 0.05).

Conclusions: The implementation of the guideline produced a reduction in the number of investigations, standardised treatment, and reduced …

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