13 November 2019

Room to improve on paediatric gastro care?

Gastro General Practice Research

Only half of Australian GPs are keeping notes of their diagnostic assessment and ongoing management of children who present with acute gastroenteritis, researchers say.

A medical records review, and the latest CareTrack Kids study, found that children presenting with acute gastroenteritis were about 30% more likely to be managed according to clinical practice guidelines in a hospital setting compared with general practice.

The Macquarie University-led research team evaluated the documented care of almost 700 children with acute gastroenteritis across general practice, emergency departments and hospital inpatient services from 2013-14.

The medical records were compared against 35 clinical indicators of acute gastroenteritis selected by a panel of Australian GPs, paediatricians and paediatric nurses.

Adherence to the clinical practice guidelines were also separated into the “diagnosis”, “treatment” and “ongoing management” phases.

And while clinicians, and particularly GPs ,were adhering to clinical practice guidelines for treatment, there was still improvements to be made for documenting the diagnosis and ongoing management of children with acute gastroenteritis, the study found.

“Adherence in the diagnosis phase of care varied by healthcare setting, being lower in the GP setting (38.5%) than in the ED (85.7%) and hospital inpatient setting (87.1%),” the study authors said.

When patients presented to their GP for diagnosis, the patient’s observations, including temperature, heart rate, blood pressure and duration of illness, were only recorded 17% of the time, weight 21% and urine output in 14% of cases.

Dr Neroli Sunderland (PhD), co-author and research fellow at Australian Institute of Health Innovation, Macquarie University, said this information could be useful if a child’s condition was to further deteriorate.

“The problem with not having it recorded is that we don’t know whether it was assessed, and it was normal, or it wasn’t assessed in the first place,” she said.

But Dr Sunderland conceded that most cases of gastroenteritis presenting to GPs were likely to be mild and excluding some recommended observations, such as blood pressure, might be clinically justifiable.

“We also know that in medical records, there are certain things that are more likely to be documented, such as medications and any tests ordered, and we know that things like advice that’s given to patients is less likely to be documented,” she said.

The study authors acknowledged they were unable to determine whether assessment, re-assessment, treatment and advice was being provided according to clinical guidelines but was failing to be well documented.

“We’re not suggesting that GPs are doing anything wrong, we are just saying there are areas for improvement in keeping record,” Dr Sunderland said.

“We would need to do more direct observation studies and interviews to work out what’s actually happening in practice.”

In contrast, the audit of the treatment of acute gastroenteritis was found to follow best practice guidelines over 95% of the time.

This included doctors advising families against the unnecessary use of antibiotics when there was no sign of infection and deciding against unnecessary treatment or tests for the condition.

PlosOne 2019, November 7

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