Management decisions for patients with gastroenteritis affect resource use within pediatric emergency departments (EDs), and therapies using evidence-based guidelines (EBGs) has become widespread.

The objective of a new study published in Pediatrics was to determine whether the implementation of a dehydration EBG in a pediatric ED resulted in a reduction in intravenous (IV) fluid administration and the cost of care.

Here, in a single-center quality improvement initiative from 2010-2016, investigators aimed to decrease the percentage of patients with gastroenteritis who were rehydrated with IV fluids. The EBG assigned the patient a dehydration score with subsequent rehydration strategy on the basis of presenting signs and symptoms. The primary outcome was proportion of patients receiving IV fluid, which was analyzed using statistical process control methods. The secondary outcome was cost of the episode of care. Balancing measures included ED length of stay, admission rate and return visit rate within 72 hours.

Overall, 7 145 patients met the inclusion criteria with a median age of 17 months. Use of IV fluid decreased from a mean of 15% to 9% postimplementation. In addition, average episode of care-related health care costs decreased from $599 to $410. Meanwhile, there were improvements in ED length of stay, rate of admission and rate of return visits.

In inference, it was stated that implementation of an EBG for patients with gastroenteritis led to a decrease in frequency of IV administration, shorter lengths of stay and lower health care costs.

Source: Pediatrics. 2020 Jul;146(1):e20191553. doi: 10.1542/peds.2019-1553.