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Management of gastroenteritis over 10 years: changing culture and maintaining the change
Joanne Fox1, Sally Richards, Huw R Jenkins
1Department of Child Health, Children’s Hospital for Wales, Heath Park, Cardiff, UK.
Insights
An implementation program significantly reduced intravenous rehydration for acute gastroenteritis in children. This practice change was maintained long-term, showing the effectiveness of targeted guidelines and programs.
Area of Science:
- Pediatrics
- Clinical Practice Guidelines
- Healthcare Implementation Science
Background:
- Acute gastroenteritis is a common pediatric admission.
- Management guidelines aim to optimize treatment and reduce unnecessary interventions.
- Previous practice may have included overuse of intravenous rehydration.
Purpose of the Study:
- To evaluate the impact of an implementation program on adherence to acute gastroenteritis management guidelines.
- To assess the sustainability of practice changes following the program.
Main Methods:
- Retrospective audit of 447 children under 5 admitted with acute gastroenteritis over 10 years.
- Four cross-sectional samples were analyzed (1999, 2002, 2004, 2009).
- An implementation strategy was introduced after the second audit (2002).
Main Results:
- The rate of intravenous rehydration decreased significantly from 20% (1999) and 15% (2002) to 4% (2004) post-implementation.
- This reduced rate was sustained at 6% in 2009.
- The implementation program was directly linked to the observed practice change.
Conclusions:
- A targeted implementation program is crucial for changing clinical practice regarding acute gastroenteritis management.
- Once adopted, practice changes can be maintained even without ongoing targeted training.
- Effective clinical practice improvement requires clear guidelines coupled with a robust implementation strategy.
Objective:
To examine the impact of an implementation program on adherence to a guideline for the management of acute gastroenteritis.
Design:
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.
Setting:
Tertiary children's hospital in South Wales.
Participants:
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).
Main Outcome Measures:
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).
Conclusion:
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.
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