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DA Lemberg, AS Day, M Brydon

Departments of Gastroenterology and General Medicine, Sydney Children’s Hospital and University of NSW, NSW, Australia

INTRODUCTION AND RATIONALE: Clinical Pathways are useful tools in improving the quality of care of patients treated in hospitals. Gastroenteritis is a short self-limiting but common illness of childhood associated with significant costs to the community. We hypothesized that children with gastroenteritis on a clinical pathway would not only have a uniform safe standard of care but would also have a reduced number of unnecessary investigations performed during initial management. We assessed the impact of a clinical pathway upon investigation ordering in children with gastroenteritis.

METHODS: A retrospective analysis of two cohorts of children was performed prior (n=1498) to and after (n=1252) the introduction of a clinical pathway. Children admitted to hospital with a diagnosis of gastroenteritis were assessed as to the type of pathology tests ordered. Further outcomes measured were rates of admission, emergency department presentations, average length of stay and direct costs for each patient admission. Subset analysis was undertaken on the initial cohort of patients who had a full blood count (FBC) as part of their initial assessment. Chart review was completed for patients with abnormal FBC parameters.

RESULTS: FBC was more likely to be performed prior to the introduction of the pathway (77.1%) than after the introduction of the pathway (66.8%) (p<0.004). Urine microscopy and culture was also significantly decreased from 56.3% to 40.4% (p<0.0005). Patient costs were reduced $1228 compared with $752 (p<0.0001), however rates of admission were increased from 18.6% to 28.8% (p<0.0001). Length of stay was decreased but was not statistically significant. FBC results in the subset analysis revealed that the measurement of a FBC had no impact upon management.

CONCLUSIONS: A Clinical pathway contributed to more rational ordering of pathology tests and lowered the costs to a hospital of caring for patients with this common illness. This is particularly important for an illness that has a significant burden, including financially, on both the hospital system and the community at large.

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