G118(P) Are diagnostic-therapeutic pathways really effective?

• Published in: Archives of disease in childhood Vol. 105; no. Suppl 1; p. A39
• Main Authors: Pin, JN, Moras, P, Minute, M, Scozzola, F, Berto, E, Giancaspro, R, Crotti, P, Martelossi, S
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.10.2020
• Subjects: Data Analysis; Emergency medical care; Gastroenteritis; Intravenous administration; Medical diagnosis; Nursing; Patients; Pediatrics; Rehydration
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2020-rcpch.94

IntroductionDiagnostic-therapeutic pathways (DTP)are evidence based interventions aimed to organize the assistance process for specific groups of patients and to improve quality and efficiency of care, reducing variability in treatment. Gastroenteritis is one of the main causes of access to the emergency room; in most cases they don’t require urgent care provoking waste of resources and prolonged waits for all patients.AimsThe aim of the study is to demonstrate the efficacy of the protocol concerning gastroenteritis in terms of diagnosis, administration of the correct therapy and outcome through nursing and medical staff training (that took place in January 2019).MethodsData were collected from patients with gastroenteritis who arrived at the pediatric emergency room of a third-level hospital in October 2018 (GO) and February 2019 (GF).A descriptive data analysis was firstly performed; possible association between the onset of gastroenteritis and selected variables were then investigated in terms of presentation and outcome by Fisher’s exact test and Wilcoxon test.ResultsTotal number of patients with gastroenteritis in ER was comparable in October 2018 (GO 55/826, 6.7%) and February 2019 (GF 63/973, 6.5%) [p = 0.88] as well as severity of presentation (usually mild: GO 64% vs GR 59%, p = 0.7) and need for an intensive short-stay observation (ISO) (GO 21.8% vs GF 23.85, p = 0.88).Increased nurses’ responsibilities did not provoke the raise of antiemetic drugs’ administration (GO = 27.3% vs GF = 30.2%, p = 1) but at the same time oral rehydration was started earlier (before medical examination: GO = 1.8% vs GF 27%, p <0.01) with a lower use of intravenous rehydration (GO = 23.6% vs GF 17.5%, p = 0.49). Furthermore, permanence in ER was strongly reduced (GO = 18 hrs vs GF 12.5 hrs, -30%, p = 0.07) as well in ISO unit (GO = 18.5 hrs vs GE = 13 hrs, -29%, p = 0.12).ConclusionsThis study shows that a simple diagnostic-therapeutic pathway can reduce about 3500 hours of ER use annually, which lead to an estimated saving of 30.000–100.00 euros (direct health care cost only).