Appropriate management of acute gastroenteritis in Australian children: a population-based study

Neroli Sunderland, Johanna Westbrook, Rachel Urwin, Zoe Knights, Jonny Taitz, Helena Williams, Louise K. Wiles, Charlotte Molloy, Peter Hibbert, Hsuen P. Ting, Kate Churruca, Gaston Arnolda, Jeffrey Braithwaite, CareTrack Kids Investigative Team

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: To determine the proportion of care provided to children with acute gastroenteritis (AGE) in Australia consistent with clinical practice guidelines. Methods: Indicators were developed from national and international clinical practice guideline (CPG) recommendations and validated by an expert panel. Medical records from children ≤15 years presenting with AGE in three healthcare settings–Emergency Department (ED), hospital admissions and General Practitioner (GP) consultations–from randomly selected health districts across three Australian States were reviewed. Records were audited against 35 indicators by trained paediatric nurses, to determine adherence to CPGs during diagnosis, treatment, and ongoing management. Results: A total of 14,434 indicator assessments were performed from 854 healthcare visits for AGE by 669 children, across 75 GPs, 34 EDs and 26 hospital inpatient services. Documented adherence to guidelines across all healthcare settings was 45.5% for indicators relating to diagnosis (95% CI: 40.7–50.4), 96.1% for treatment (95% CI: 94.8–97.1) and 57.6% for ongoing management (95% CI: 51.3–63.7). Adherence varied by healthcare setting, with adherence in GPs (54.6%; 95% CI: 51.1–58.1) lower than for either ED settings (84.7%; 95% CI: 82.4–86.9) or for inpatients (84.3%; 95% CI: 80.0–87.9); p<0.0001 for both differences. The difference between settings was driven by differences in the diagnosis and ongoing management phases of care. Conclusions: Adherence to clinical guidelines for children presenting to healthcare providers with AGE varies according to phase of care and healthcare setting. Although appropriate diagnostic assessment and ongoing management phase procedures are not well documented in medical records (particularly in the GP setting), in the treatment phase children are treated in accordance with guidelines over 90% of the time.

LanguageEnglish
Article numbere0224681
Pages1-15
Number of pages15
JournalPLoS ONE
Volume14
Issue number11
DOIs
Publication statusPublished - 1 Jan 2019

Fingerprint

gastroenteritis
Gastroenteritis
health services
Delivery of Health Care
Population
general practitioners
Practice Guidelines
General Practitioners
Medical Records
Hospital Emergency Service
Inpatients
Pediatrics
Guidelines
Guideline Adherence
Health Personnel
Health
nurses
Therapeutics
Referral and Consultation

Bibliographical note

Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Cite this

Sunderland, N., Westbrook, J., Urwin, R., Knights, Z., Taitz, J., Williams, H., ... CareTrack Kids Investigative Team (2019). Appropriate management of acute gastroenteritis in Australian children: a population-based study. PLoS ONE, 14(11), 1-15. [e0224681]. https://doi.org/10.1371/journal.pone.0224681
Sunderland, Neroli ; Westbrook, Johanna ; Urwin, Rachel ; Knights, Zoe ; Taitz, Jonny ; Williams, Helena ; Wiles, Louise K. ; Molloy, Charlotte ; Hibbert, Peter ; Ting, Hsuen P. ; Churruca, Kate ; Arnolda, Gaston ; Braithwaite, Jeffrey ; CareTrack Kids Investigative Team. / Appropriate management of acute gastroenteritis in Australian children : a population-based study. In: PLoS ONE. 2019 ; Vol. 14, No. 11. pp. 1-15.
@article{47e5aad3f3e14d6db119e4e187a6c2c0,
title = "Appropriate management of acute gastroenteritis in Australian children: a population-based study",
abstract = "Objectives: To determine the proportion of care provided to children with acute gastroenteritis (AGE) in Australia consistent with clinical practice guidelines. Methods: Indicators were developed from national and international clinical practice guideline (CPG) recommendations and validated by an expert panel. Medical records from children ≤15 years presenting with AGE in three healthcare settings–Emergency Department (ED), hospital admissions and General Practitioner (GP) consultations–from randomly selected health districts across three Australian States were reviewed. Records were audited against 35 indicators by trained paediatric nurses, to determine adherence to CPGs during diagnosis, treatment, and ongoing management. Results: A total of 14,434 indicator assessments were performed from 854 healthcare visits for AGE by 669 children, across 75 GPs, 34 EDs and 26 hospital inpatient services. Documented adherence to guidelines across all healthcare settings was 45.5{\%} for indicators relating to diagnosis (95{\%} CI: 40.7–50.4), 96.1{\%} for treatment (95{\%} CI: 94.8–97.1) and 57.6{\%} for ongoing management (95{\%} CI: 51.3–63.7). Adherence varied by healthcare setting, with adherence in GPs (54.6{\%}; 95{\%} CI: 51.1–58.1) lower than for either ED settings (84.7{\%}; 95{\%} CI: 82.4–86.9) or for inpatients (84.3{\%}; 95{\%} CI: 80.0–87.9); p<0.0001 for both differences. The difference between settings was driven by differences in the diagnosis and ongoing management phases of care. Conclusions: Adherence to clinical guidelines for children presenting to healthcare providers with AGE varies according to phase of care and healthcare setting. Although appropriate diagnostic assessment and ongoing management phase procedures are not well documented in medical records (particularly in the GP setting), in the treatment phase children are treated in accordance with guidelines over 90{\%} of the time.",
author = "Neroli Sunderland and Johanna Westbrook and Rachel Urwin and Zoe Knights and Jonny Taitz and Helena Williams and Wiles, {Louise K.} and Charlotte Molloy and Peter Hibbert and Ting, {Hsuen P.} and Kate Churruca and Gaston Arnolda and Jeffrey Braithwaite and {CareTrack Kids Investigative Team}",
note = "Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",
year = "2019",
month = "1",
day = "1",
doi = "10.1371/journal.pone.0224681",
language = "English",
volume = "14",
pages = "1--15",
journal = "PLoS ONE",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "11",

}

Appropriate management of acute gastroenteritis in Australian children : a population-based study. / Sunderland, Neroli; Westbrook, Johanna; Urwin, Rachel; Knights, Zoe; Taitz, Jonny; Williams, Helena; Wiles, Louise K.; Molloy, Charlotte; Hibbert, Peter; Ting, Hsuen P.; Churruca, Kate; Arnolda, Gaston; Braithwaite, Jeffrey; CareTrack Kids Investigative Team.

In: PLoS ONE, Vol. 14, No. 11, e0224681, 01.01.2019, p. 1-15.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Appropriate management of acute gastroenteritis in Australian children

T2 - PLoS ONE

AU - Sunderland, Neroli

AU - Westbrook, Johanna

AU - Urwin, Rachel

AU - Knights, Zoe

AU - Taitz, Jonny

AU - Williams, Helena

AU - Wiles, Louise K.

AU - Molloy, Charlotte

AU - Hibbert, Peter

AU - Ting, Hsuen P.

AU - Churruca, Kate

AU - Arnolda, Gaston

AU - Braithwaite, Jeffrey

AU - CareTrack Kids Investigative Team

N1 - Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: To determine the proportion of care provided to children with acute gastroenteritis (AGE) in Australia consistent with clinical practice guidelines. Methods: Indicators were developed from national and international clinical practice guideline (CPG) recommendations and validated by an expert panel. Medical records from children ≤15 years presenting with AGE in three healthcare settings–Emergency Department (ED), hospital admissions and General Practitioner (GP) consultations–from randomly selected health districts across three Australian States were reviewed. Records were audited against 35 indicators by trained paediatric nurses, to determine adherence to CPGs during diagnosis, treatment, and ongoing management. Results: A total of 14,434 indicator assessments were performed from 854 healthcare visits for AGE by 669 children, across 75 GPs, 34 EDs and 26 hospital inpatient services. Documented adherence to guidelines across all healthcare settings was 45.5% for indicators relating to diagnosis (95% CI: 40.7–50.4), 96.1% for treatment (95% CI: 94.8–97.1) and 57.6% for ongoing management (95% CI: 51.3–63.7). Adherence varied by healthcare setting, with adherence in GPs (54.6%; 95% CI: 51.1–58.1) lower than for either ED settings (84.7%; 95% CI: 82.4–86.9) or for inpatients (84.3%; 95% CI: 80.0–87.9); p<0.0001 for both differences. The difference between settings was driven by differences in the diagnosis and ongoing management phases of care. Conclusions: Adherence to clinical guidelines for children presenting to healthcare providers with AGE varies according to phase of care and healthcare setting. Although appropriate diagnostic assessment and ongoing management phase procedures are not well documented in medical records (particularly in the GP setting), in the treatment phase children are treated in accordance with guidelines over 90% of the time.

AB - Objectives: To determine the proportion of care provided to children with acute gastroenteritis (AGE) in Australia consistent with clinical practice guidelines. Methods: Indicators were developed from national and international clinical practice guideline (CPG) recommendations and validated by an expert panel. Medical records from children ≤15 years presenting with AGE in three healthcare settings–Emergency Department (ED), hospital admissions and General Practitioner (GP) consultations–from randomly selected health districts across three Australian States were reviewed. Records were audited against 35 indicators by trained paediatric nurses, to determine adherence to CPGs during diagnosis, treatment, and ongoing management. Results: A total of 14,434 indicator assessments were performed from 854 healthcare visits for AGE by 669 children, across 75 GPs, 34 EDs and 26 hospital inpatient services. Documented adherence to guidelines across all healthcare settings was 45.5% for indicators relating to diagnosis (95% CI: 40.7–50.4), 96.1% for treatment (95% CI: 94.8–97.1) and 57.6% for ongoing management (95% CI: 51.3–63.7). Adherence varied by healthcare setting, with adherence in GPs (54.6%; 95% CI: 51.1–58.1) lower than for either ED settings (84.7%; 95% CI: 82.4–86.9) or for inpatients (84.3%; 95% CI: 80.0–87.9); p<0.0001 for both differences. The difference between settings was driven by differences in the diagnosis and ongoing management phases of care. Conclusions: Adherence to clinical guidelines for children presenting to healthcare providers with AGE varies according to phase of care and healthcare setting. Although appropriate diagnostic assessment and ongoing management phase procedures are not well documented in medical records (particularly in the GP setting), in the treatment phase children are treated in accordance with guidelines over 90% of the time.

UR - http://www.scopus.com/inward/record.url?scp=85074651297&partnerID=8YFLogxK

UR - http://purl.org/au-research/grants/nhmrc/1065898

U2 - 10.1371/journal.pone.0224681

DO - 10.1371/journal.pone.0224681

M3 - Article

VL - 14

SP - 1

EP - 15

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 11

M1 - e0224681

ER -