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Updated: Mar 6, 2026

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
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The Use of a Triage-Based Protocol for Oral Rehydration in a Pediatric Emergency Department

Marissa A Hendrickson, Jennifer Zaremba, Andrew R Wey

    Pediatric Emergency Care
    |March 10, 2017
    PubMed

    Insights

    A new protocol for pediatric emergency departments safely improves care for children with gastroenteritis. Early use of oral ondansetron and oral rehydration therapy (ORT) reduced IV fluids and blood tests without increasing wait times or admissions.

    Area of Science:

    • Pediatric Emergency Medicine
    • Gastroenterology
    • Evidence-Based Practice

    Background:

    • Current guidelines recommend oral rehydration therapy (ORT) and avoiding laboratory tests and intravenous fluids for mild to moderate dehydration in children with gastroenteritis.
    • Oral ondansetron is an effective adjunct therapy for gastroenteritis.

    Purpose of the Study:

    • To determine if a triage-based, nurse-initiated protocol for early provision of ondansetron and ORT could safely improve care for pediatric emergency department (ED) patients with gastroenteritis symptoms.

    Main Methods:

    • Evaluated a protocol prompting triage nurses to assess dehydration in gastroenteritis patients and initiate ondansetron and ORT if indicated.
    • Compared prospective postintervention data with retrospective, preintervention control subjects for patients aged 6 months to 5 years.

    Main Results:

    • Ondansetron use increased from 36% to 75%, with time to administration decreasing from 60 to 30 minutes.
    • Documented ORT increased from 51% to 100%.
    • Blood testing decreased from 37% to 21%, and intravenous fluid use decreased from 23% to 9%.

    Conclusions:

    • A triage nurse-initiated protocol for early oral ondansetron and ORT in children with gastroenteritis increases and expedites the use of these treatments.
    • The protocol decreases the need for IV fluids and blood testing without negatively impacting ED length of stay, admissions, or return care rates.
    Abstract

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