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dc.contributor.authorPatel, Perseus Vistasp
dc.contributor.authorWallach, Thomas
dc.contributor.authorRosenbluth, Glenn
dc.contributor.authorHeyman, Mel
dc.contributor.authorVerstraete, Sofia
dc.date.accessioned2022-10-17T16:23:40Z
dc.date.available2022-10-17T16:23:40Z
dc.identifier.citationPatel PV, Wallach T, Rosenbluth G, Heyman M, Verstraete S. Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis. BMJ Open Qual. 2022 Mar;11(1):e001616. doi: 10.1136/bmjoq-2021-001616. PMID: 35347066; PMCID: PMC8961161.en_US
dc.identifier.eissn2399-6641
dc.identifier.doi10.1136/bmjoq-2021-001616
dc.identifier.pmid35347066
dc.identifier.urihttp://hdl.handle.net/20.500.12648/7759
dc.description.abstractIn paediatric patients with acute gastroenteritis (AGE), ondansetron use decreases the need for intravenous fluids, reduces hospitalisations and shortens illness duration. Oral rehydration is also known to have excellent outcomes for mild to moderate dehydration secondary to AGE. Although these interventions are recommended in guidelines from international professional societies, baseline data at our clinic showed that <2% of these patients were offered ondansetron, and that few patients received appropriately detailed rehydration instructions. Therefore, we engaged residents and fellows as teachers and leaders in our university clinic's quality improvement programme to promote evidence-based practice for paediatric AGE. Our gap analysis identified opportunities for interventions including educating paediatricians and paediatrics residents on the safety and utility of the medication. We created standardised oral rehydration after-visit instructions and implemented a trainee-led educational approach that encouraged appropriate medication use. We used a follow-up survey to uncover provider concerns and tailor future interventions. The process metrics included: proportion of paediatric patients appropriately treated with ondansetron (goal of 80%), and proportion of patients given appropriate oral rehydration instructions. The outcome metric was 7-day representation rates. To achieve sustainability, we restructured our process to have senior residents take ownership of teaching and data collection. Trainee-driven interventions increased ondansetron prescription rates to a median of 66.6%. Patients prescribed ondansetron were less likely to represent to care, although representation rate was low overall. Postintervention data suggests that prescription rates decreased without continued interventions and additional systems redesign may help sustain impact.en_US
dc.language.isoenen_US
dc.relation.urlhttps://bmjopenquality.bmj.com/content/11/1/e001616en_US
dc.rights© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectAmbulatory careen_US
dc.subjectContinuous quality improvementen_US
dc.subjectEducationen_US
dc.subjectEvidence-Based Practiceen_US
dc.titleImproving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis.en_US
dc.typeArticle/Reviewen_US
dc.source.journaltitleBMJ open qualityen_US
dc.source.volume11
dc.source.issue1
dc.source.countryUnited States
dc.source.countryEngland
dc.description.versionVoRen_US
refterms.dateFOA2022-10-17T16:23:40Z
dc.description.institutionSUNY Downstateen_US
dc.description.departmentPediatric Gastroenterologyen_US
dc.description.degreelevelN/Aen_US
dc.identifier.journalBMJ open quality


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© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Except where otherwise noted, this item's license is described as © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.