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Improving Isotonic Maintenance Intravenous Fluid Use in the Emergency Department.

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Pediatric emergency department patients now receive more isotonic intravenous fluids (IVFs), meeting a goal of over 80% use. This shift from hypotonic IVFs improved care without increasing electrolyte abnormalities.

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Area of Science:

  • Pediatric hospital medicine
  • Quality improvement science
  • Clinical informatics

Background:

  • Hypotonic intravenous fluids (IVFs) are frequently used in pediatric care, despite concerns regarding a high incidence of hyponatremia.
  • Current practice often favors hypotonic IVFs in children, necessitating a shift towards safer alternatives.

Purpose of the Study:

  • To increase the utilization of isotonic maintenance IVFs in children admitted from the emergency department (ED).
  • The study aimed to transition from a baseline of 20% isotonic IVF use in 2018 to over 80% by December 2019.

Main Methods:

  • Implementation of institutional discussions, education based on American Academy of Pediatrics guidelines, and electronic medical record modifications.
  • Utilized group practice review, physician audit, and feedback mechanisms.
  • Monitored serum electrolyte checks and hypernatremia occurrence as balancing measures, analyzed with statistical process control charts.

Main Results:

  • Isotonic maintenance IVF use significantly improved, achieving and sustaining the target of over 80%.
  • No statistically significant difference was observed in serum electrolyte checks within 24 hours of admission.
  • The incidence of hypernatremia did not increase in patients receiving isotonic IVFs compared to hypotonic IVFs.

Conclusions:

  • Quality improvement initiatives successfully enhanced isotonic IVF use in pediatric ED patients admitted to inpatient settings.
  • Institutional readiness for change and electronic medical record integration were key factors in the successful implementation of preferred fluids.