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Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled
Dorien Geurts1, Evelien de Vos-Kerkhof2, Suzanne Polinder3
1Department of Pediatrics, Erasmus MC - Sophia children's hospital, Wytemaweg 80, Rotterdam, CN, 3015, The Netherlands. d.geurts@erasmusmc.nl.
Insights
A nurse-guided system improved oral rehydration solution use in children with acute gastroenteritis. This approach proved feasible and increased standardized treatment without affecting other outcomes in the emergency department.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision Support Systems
- Gastroenterology
Background:
- Acute gastroenteritis (AGE) is a leading cause of pediatric emergency department visits.
- Standardized oral rehydration therapy (ORT) for mild to moderate dehydration is recommended but often underutilized.
- Implementing evidence-based guidelines in emergency settings presents challenges.
Purpose of the Study:
- To assess the feasibility of a nurse-guided clinical decision support system (CDSS) for AGE rehydration.
- To evaluate the impact of the CDSS on diagnostics, treatment, and costs compared to usual physician care.
- To measure the effect on standardized oral rehydration solution (ORS) use.
Main Methods:
- A randomized controlled trial involving 222 children aged 1 month to 5 years with AGE.
- Comparison between a nurse-guided CDSS intervention group and a usual care group.
- Outcomes included nurse compliance, length of stay, diagnostic tests, treatment, follow-up, and costs.
Main Results:
- The nurse-guided CDSS demonstrated high compliance rates among nurses.
- Standardized ORS use significantly increased from 52% to 65% in the intervention group.
- No significant differences were observed in length of stay, diagnostic tests, or costs.
Conclusions:
- Nurse-guided CDSS implementation is feasible for managing pediatric AGE.
- The system effectively increased standardized ORS use, aligning with clinical guidelines.
- Further research in well-equipped emergency departments is warranted to optimize care delivery.
Abstract:
Acute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children's hospital in The Netherlands ( 2010-2012). Outcome included (1) feasibility, measured by compliance of the nurses, and (2) length of stay (LOS) at the ED, the number of diagnostic tests, treatment, follow-up, and costs. Due to failure of post-ED weight measurement, we could not evaluate weight difference as measure for dehydration. Patient characteristics were comparable between the intervention (N = 113) and the usual care group (N = 109). Implementation of the clinical decision support system proved a high compliance rate. The standardized use of oral ORS (oral rehydration solution) significantly increased from 52 to 65%(RR2.2, 95%CI 1.09-4.31 p < 0.05). We observed no differences in other outcome measures.
Conclusion:
Implementation of nurse-guided clinical decision support system on rehydration treatment in children with AGE showed high compliance and increase standardized use of ORS, without differences in other outcome measures. What is Known: • Acute gastroenteritis is one of the most frequently encountered problems in pediatric emergency departments. • Guidelines advocate standardized oral treatment in children with mild to moderate dehydration, but appear to be applied infrequently in clinical practice. What is New: • Implementation of a nurse-guided clinical decision support system on treatment of AGE in young children showed good feasibility, resulting in a more standardized ORS use in children with mild to moderate dehydration, compared to usual care. • Given the challenges to perform research in emergency care setting, the ED should be experienced and adequately equipped, especially during peak times.
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