title: Management of gastroenteritis over 10 years: changing culture and maintaining the change.
abstract: OBJECTIVE
  To examine the impact of an implementation program on adherence to a guideline for the management of acute gastroenteritis.
  
  
  METHODS
  Using four retrospective audits over a 10-year period, the authors examined the change in practice and maintenance of that change following a targeted implementation program for the clinical guideline.
  
  
  METHODS
  Tertiary children's hospital in South Wales.
  
  
  METHODS
  447 children aged less than 5 years, admitted to hospital with acute gastroenteritis, comprising four cross-sectional samples (106 in 1999, 153 in 2002, 99 in 2004, 89 in 2009).
  
  
  METHODS
  Age of child, hydration status, method of rehydration and duration of admission, for each audit, with an implementation strategy delivered after the second audit.
  
  
  RESULTS
  In 1999 and 2002, intravenous rehydration was used in 20% and 15% of cases, respectively. After the implementation program in 2004, compared to 1999, there was a significant decrease in the intravenous rehydration rate to 4% in 2004 (p<0.001); in 2009 the intravenous rehydration rate was maintained at a low level of 6% (p<0.001).
  
  
  CONCLUSIONS
  It was only after the implementation program that a change in practice was achieved. Once change had been accepted, it was maintained even in the absence of targeted training. Audit does not improve clinical practice unless, in addition, there is a clear, succinct guideline with an implementation programme in place.
authors.affiliation: Department of Child Health, Children’s Hospital for Wales, Heath Park, Cardiff, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Fox
authors.forename: Sally
authors.initials: S
authors.lastname: Richards
authors.forename: Huw R
authors.initials: HR
authors.lastname: Jenkins
authors.forename: Colin
authors.initials: C
authors.lastname: Powell
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D002675:Child, Preschool; D005440:Fluid Therapy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D005759:Gastroenteritis / Q000628:therapy*; D019983:Guideline Adherence; D006760:Hospitalization; D006776:Hospitals, Pediatric / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008485:Medical Audit; D015279:Organizational Culture; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000706:statistics & numerical data*; D014852:Wales