Room for improvement for doctors caring for kids with gastro

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There is room for improvement in terms of how doctors care for kids with acute gastro, say Australian researchers who found that while kids' treatment usually adheres to guidelines, some other elements of care, including recording key information during diagnosis, happen in as little as five percent of cases. The study looked at how around 700 kids across three states were cared for in emergency departments, hospitals and in GP clinics, and found that many GPs failed to record key information such as kids temperature, heart rate, and blood pressure - and its not clear if this was not taken or just not recorded. The researchers say following the guidelines can reduce hospitalisation rates and the costs of care by up to 50 per cent.

Journal/conference: PLOS ONE

DOI: 10.1371/journal.pone.0224681

Organisation/s: Macquarie University, Children's Hospital at Westmead, University of South Australia, South Australian Health and Medical Research Institute (SAHMRI)

Funder: This work was supported by an Australian National Health and Medical Research Council Partnership Grant (APP1065898), with contributions by the National Health and Medical Research Council, Bupa Health Foundation, Sydney Children’s Hospital Network, New South Wales Kids and Families, Children’s Health Queensland and the South Australian Department of Health (SA Health).

Media Release

From: Macquarie University

Improvement needed for care of children with acute gastro

New research findings from the Australian Institute of Health Innovation

Treatment for children with acute gastroenteritis follows clinical practice guidelines 90% of the time but drops to around 50% adherence for best practice diagnosis and ongoing management of the condition.

New research from the Australian Institute of Health Innovation, Macquarie University, published in the journal PLOS One, evaluated the documented care of almost 700 children with acute gastroenteritis which is the leading cause of hospitalisation of children in Australia.

Acute gastroenteritis symptoms can include vomiting and diarrhoea for concurrent days, possibly accompanied by high temperatures and abdominal pain.

Lead author, Dr Neroli Sunderland, Research Fellow with the Australian Institute of Health Innovation, said that while clinicians and particularly GPs were adhering to clinical practice guidelines for treating children with acute gastroenteritis, improvements could be made in the areas of documenting diagnosis and ongoing management of the condition.

“Following clinical practice guidelines and keeping thorough and accurate medical records are both very important steps to ensuring children receive the best care available,” Dr Sunderland said.

Clinical practice guidelines are developed by experts and available to assist health professionals to provide appropriate and evidence-based care for children.

“Studies from overseas have shown that children who are treated in line with clinical practice guidelines recover from this illness faster,” Dr Sunderland stated.

An important aspect of care is in the taking of routine observations for a child presenting with vomiting or diarrhoea, or both, that has been going on for days and may be accompanied by a high temperature, reduced fluid intake and lack of appetite. Overall, only 16.8% of children had their observations recorded, which can include details about the duration of the illness plus the child’s temperature, heart rate, blood pressure and weight.

Across all settings, GP, ED and in hospital, only 27.4% of babies under one-year old presenting with symptoms of acute gastroenteritis had their fontanelles assessed and recorded—depression of the anterior fontanelle is a clinical sign of dehydration in infants.

Also, when presenting to GPs only 14.2% of children had their urine output recorded (an indicator for dehydration) and less than a quarter had their weight recorded.

Dr Sunderland said: “It is pleasing to see that in 95% of cases, families were advised against the unnecessary use of antibiotics when there was no sign of infection.”

Dr Sunderland said: “While this study shows that the care Australian children receive is of a high standard, there are areas for improvement including the adoption of consistent national clinical guidelines that would make it easier for clinicians to provide the best possible care.”

The study evaluated the documented care in 2012 and 2013 of 669 children across 75 GPs, 34 emergency departments and 26 inpatient hospital services in New South Wales, Queensland and South Australia.

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