Implementing an evidence-based acute gastroenteritis guideline at a children's hospital.
BACKGROUND
Guidelines for preventing and treating acute gastroenteritis (AGE) have generally not been incorporated into medical practice. An evidence-based clinical practice guideline was adapted from national guidelines to meet the practice styles characterizing care in southwestern Ohio and implemented at the Children's Hospital Medical Center (Cincinnati). Its efficacy was assessed in terms of emergency department (ED) encounters and admissions, mean and total hospital costs, and mean length of hospitalization.


METHODS
Comparisons were made between patients seen during peak gastroenteritis months (December-May) before (fiscal year [FYs] 1994-1997) and after (FYs 1998 and 1999) guideline implementation. Data were extracted from hospital charts, clinical databases, and billing records.


RESULTS
Following implementation, mean yearly ED encounters for AGE decreased 22% and mean yearly admissions decreased 33%. The percentage of admitted children with minor illness decreased (p = 0.002). Mean length of stay decreased 21% for children with minor illness (p = 0.0001) and 5% for others. Hydration status was noted in only 15% of ED charts examined but increased to 63% in FY 1998 and 86% in FY 1999 (p < 0.001). The proportion of admitted patients who advanced to a regular diet by discharge increased from 4.9% (FY 1997) to 23% (FY 1998) and 76% (FY 1999; p < 0.0001). Total inpatient days/year decreased by 43%. Mean hospital costs did not change significantly.


CONCLUSIONS
Following implementation, fewer patients with AGE were seen in the ED and fewer were admitted to the hospital for care. Hospital stays were shorter, and children were more likely to resume their diets before discharge.
Perlstein
Paul H
PH
Division of Health Policy and Clinical Effectiveness, Department of Neonatology, Children's Hospital Medical Center (CHMC), Cincinnati, Ohio, USA.
Lichtenstein
Philip
P
Cohen
Mitchell B
MB
Ruddy
Richard
R
Schoettker
Pamela J
PJ
Atherton
Harry D
HD
Kotagal
Uma
U
D000208:Acute Disease; D002675:Child, Preschool; D003681:Dehydration / Q000209:etiology / Q000517:prevention & control; D003968:Diarrhea, Infantile / Q000150:complications / Q000191:economics / Q000209:etiology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000592:standards*; D005759:Gastroenteritis / Q000150:complications / Q000191:economics / Q000628:therapy*; D019983:Guideline Adherence; D006776:Hospitals, Pediatric / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D009820:Ohio; D010343:Patient Admission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012955:Societies, Medical