Wolters, Ruth (2024) Evaluatie van de naleving van Isala’s richtlijn ‘Gastro-enteritis en dehydratie bij kinderen’: doen we het goed? Een zorgevaluatieonderzoek middels retrospectief databaseonderzoek, kwalitatief onderzoek aan de hand van semigestructureerde interviews & vergelijkend richtlijnenonderzoek. thesis, Medicine.
Full text available on request.Abstract
Background. Dehydration in gastroenteritis (GE) is a common issue in young children, with internationally described unnecessary overuse of diagnostics or intravenous (IV) rehydration. Isala's guideline recommends enteral rehydration via a nasogastric tube with ORS 20ml/kg/hour for 4 hours, followed by 2 hours of observation, without routine diagnostics. IV-rehydration is indicated only in cases of ‘shock’, laboratory tests for ‘severe dehydration’, a fecal culture for ‘bloody diarrhea’, and ondansetron for ‘significant vomiting’. Objective. Evaluation of adherence to Isala's guideline 'Gastroenteritis and dehydration'. Method. The guideline was evaluated using a mixed-methods design. Retrospective data collection included children (aged 3 months to 5 years) with GE between 01-2019 and 07-2023. Length of stay, reassessment, ondansetron use, IV-rehydration, fecal culture, and laboratory tests with indications were examined. Practice variation was analyzed through guideline research, and by comparing data from the mProve-network. Semistructured interviews were conducted with parents, and those were analyzed using coding and thematic analysis. Results. Of the analyzed patients (n=659), a minority (43.2%) were hospitalized, with a median length of stay of 17 hours (IQR: 11-23). 1.4% received an IV, 5.5% had a fecal culture, 7.9% underwent laboratory tests, and 62.4% received ondansetron. Laboratory tests were appropriately indicated in 18% of cases, and fecal cultures in 28%. Minor practice variation was observed in guidelines and within the mProve-network. Parents (n=3) were generally satisfied, but confusion and stress arose from long waiting times and unclear advice. Conclusion. Adherence to Isala's guideline is generally good, with minimal use of diagnostics and IV-rehydration. However, the length of hospital stay exceeds recommendations. While parents are generally satisfied, there is a need for better communication and expectation management.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Bekhof, Dr. J. |
| Faculty: | Medical Sciences |
| Date Deposited: | 11 Feb 2025 12:05 |
| Last Modified: | 11 Feb 2025 12:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3803 |
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