Source: Annual Congress 2002 - Miscellaneous respiratory infections in children
Disease area: Paediatric lung diseases

Abstract

Aim: Guidelines have been shown to change clinical behaviour if implemented and evaluated successfully. We aimed to evaluate the implementation of an evidence based guideline on the management of the child presenting with an acute breathing difficulty.
Method: An evidence based guideline was developed by completing a systematic literature review and presenting recommendations to a national panel of 50 medical and nursing staff using the Delphi consensus development technique. The resulting guideline was implemented as an algorithm in the emergency department. Data on investigation, treatment and cost of care was collected during four month periods before and after implementation.
Results: Data was analysed on 979 children before guideline implementation and 442 children after the implementation. There was a significant increase in the number of children having their oxygen saturations and respiratory rate observed (fisher exact p less than 0.001 and p=0.001 ). A significant decrease in the number of urea and electrolytes, c-reactive protein, blood culture and chest x-ray (fisher exact p=0.002, p=0.002, p=0.001, p less than 0.001 respectively) was found. More children were admitted to hospital post implementation (fisher exact p=0.04) but there was significantly less children re-attending the department within 24 hours (fisher exact p=0.001). The total cost of attending to a child fell significantly from [brpound]78.33 to [brpound]74.73 (p is less than 0.05).
Conclusion: The implementation of the guideline produced a reduction in the number of investigations, standardised treatment and reduced the cost of managing the child in the acute department.

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Citations should be made in the following way:
M. Lakhanpaul, P. Lorgelly, T. J. Stephenson, R. MacFaul, U. Werneke (Nottingham, United Kingdom). Implementation of an evidence-based guideline for children presenting with an acute breathing difficulty. Eur Respir J 2002; 20: Suppl. 38, 2095

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