title: Impact of a pilot pathway for the management of gastroenteritis-like symptoms in an emergency department: A case study following a Salmonella outbreak.
abstract: OBJECTIVE
  This research aims to describe the effect of standard care (control) versus a clinical management pathway (intervention) on patient length of stay and admission rates during a public health emergency at one Australian ED.
  
  
  METHODS
  A retrospective audit of hospital records for patients who presented in May 2013 with gastroenteritis-like symptoms was undertaken following a surge in patient presentations from a Salmonella outbreak. Patients who presented with gastroenteritis-like symptoms between 15 and 19 May 2013 received care according to a clinical management pathway (intervention). The focus of the intervention was based on symptom management, including a standardised approach to analgesia, anti-emetics and rehydration. Patient characteristics, such as age and gender are described using descriptive statistics. A Mann-Whitney test was used to compare continuous data, and a Fisher's exact test was used to compare categorical data, between the two groups.
  
  
  RESULTS
  Over an 8 day period, 110 patients presented with gastroenteritis-like symptoms. The median length of stay was statistically different between the two groups (P < 0.001). More patients were admitted to hospital from the control group (n = 5) when compared with the intervention group (n = 0); however, given the small number of patients in these groups, inferential statistical analysis was not a reasonable consideration.
  
  
  CONCLUSIONS
  The length of stay for patients between the two groups was statistically different, suggesting that the implementation of a clinical management pathway for patients with gastroenteritis-like symptoms reduced the ED length of stay. This finding is useful in future planning for similar public health emergency responses and/or for use when patients present with gastroenteritis-like symptoms on a daily basis.
authors.affiliation: Emergency Department, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia.|Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.
authors.forename: Jamie
authors.identifier: http://orcid.org/0000-0002-5265-6365
authors.initials: J
authors.lastname: Ranse
authors.affiliation: Emergency Department, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia.
authors.forename: Matt
authors.initials: M
authors.lastname: Luther
authors.affiliation: Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.
authors.forename: Kristen
authors.initials: K
authors.lastname: Ranse
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D019091:Critical Pathways; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D012478:Salmonella Food Poisoning / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult
keywords: Salmonella; disaster medicine; disease outbreak; emergency medicine; gastroenteritis; public health