The Use of a Triage-Based Protocol for Oral Rehydration in a Pediatric Emergency Department

Marissa A. Hendrickson, Jennifer Zaremba, Andrew R. Wey, Philippe R. Gaillard, Anupam B. Kharbanda

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background Guidelines recommend oral rehydration therapy (ORT) and avoidance of laboratory tests and intravenous fluids for mild to moderate dehydration in children with gastroenteritis; oral ondansetron has been shown to be an effective adjunct. Objectives The aim of this study was to determine if a triage-based, nurse-initiated protocol for early provision of ondansetron and ORT could safely improve the care of pediatric emergency department (ED) patients with symptoms of gastroenteritis. Methods This study evaluated a protocol prompting triage nurses to assess dehydration in gastroenteritis patients and initiate ondansetron and ORT if indicated. Otherwise well patients aged 6 months to 5 years with symptoms of gastroenteritis were eligible. Prospective postintervention data were compared with retrospective, preintervention control subjects. Results One hundred twenty-eight (81 postintervention and 47 preintervention) patients were analyzed; average age was 2.1 years. Ondansetron use increased from 36% to 75% (P < 0.001). Time to ondansetron decreased from 60 minutes to 30 minutes (P = 0.004). Documented ORT increased from 51% to 100% (P < 0.001). Blood testing decreased from 37% to 21% (P = 0.007); intravenous fluid decreased from 23% to 9% (P = 0.03). Fifty-two percent of postintervention patients were discharged with prescriptions for ondansetron. There were no significant changes in ED length of stay, admissions, or unscheduled return to care. Conclusions A triage nurse-initiated protocol for early use of oral ondansetron and ORT in children with evidence of gastroenteritis is associated with increased and earlier use of ondansetron and ORT and decreased use of IV fluids and blood testing without lengthening ED stays or increasing rates of admission or unscheduled return to care.

Original languageEnglish (US)
Pages (from-to)227-232
Number of pages6
JournalPediatric Emergency Care
Volume34
Issue number4
DOIs
StatePublished - Apr 1 2018

Bibliographical note

Funding Information:
From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota Medical School, and †University of Minnesota Masonic Children’s Hospital, Minneapolis, MN; ‡Biostatistics and Data Management Core, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; §Department of Mathematics and Statistics, Auburn University, Auburn, AL; and ||Department of Pediatric Emergency Medicine, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN. This investigation was partially funded by a grant from the ABIM Foundation, Putting the Charter into Practice grant 242. A.R.W. and P.R.G. were supported in part by grant UL1TR000114 of the National Center for Advancing Translational Sciences. Funding sources had no role in study design, data collection, analysis, or interpretation, manuscript preparation, or decision to submit the article for publication. Disclosure: The authors declare no conflict of interest. Reprints: Marissa A. Hendrickson, MD, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota Medical School, M653 E Bldg, 2450 Riverside Ave, Minneapolis, MN 55454; e-mail: ( mhendric@umn.edu). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0749-5161

Keywords

  • dehydration
  • gastroenteritis
  • ondansetron
  • oral rehydration
  • triage

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