Abstract 752
Health Services Research: Measures & Outcomes Poster Symposium, Sunday, 5/2
The implementation of EBCPG with recommendations for management of children with AGE encountered in the emergency department (ED) or provided inpatient care at CHMC was followed by significant changes in practices. Methods: The EBCPG was developed by a multidisciplinary team of community and hospital based physicians, nurses, and others who queried electronic databases of scientific articles describing best practices. The guideline was published in November 1997 and was for children 2 months to 5 years old, reflected the most current recommendations from the AAP, and emphasized use of regular diets early in the disease. For dehydrated children, the recommendation was to use oral rehydration solutions (ORS) as alternatives to IV fluids with very prompt refeeding with regular diets. Analyses: Data on all eligible patients encountered in the ED, November, 1996 through April, 1997 were extracted from the hospital information systems. These data, generated before guideline implementation (BEFORE), were used for making comparisons with patients encountered in the same 6 month period in 1997-1998 (AFTER). Results: 1,892 patients were encountered in the ED BEFORE and 733 (39%) fewer or 1,159 patients were seen in the ED in the AFTER period. 12% more of the patients seen in the ED were admitted after guideline implementation compared to BEFORE. Mean lengths of stay (LOS) for admitted patients were similar at 1.6 days per patient, but the variance in LOS expressed as the standard deviation (SD) AFTER was ±0.8 days and significantly less by 62% when compared to the ±2.1 days SD BEFORE (p<.001). The mean per patient total costs for all inpatient care fell 24% from between the two time periods. Both the change in costs and cost variances are significant at p<.001. For inpatients, 73% of children considered to be well hydrated, and 87% of children dehydrated were treated in accordance with guideline expectations. Conclusions: Apparently, in its first year of implementation an EBCPG for AGE was well accepted by the local medical community. The marked reduction in the number of patients seen in the ED for AGE is speculated to have resulted because diarrhea and dehydration were limited by physicians encouraging parents to continue regular feedings, and the use of ORS in the home. The 12% higher percent of ED patients admitted following guideline implementation is interpreted as evidence that sicker AGE candidates for ED care were referred in the AFTER period.
