The Implementation of a Gastroenteritis Education Program
The Implementation of a Gastroenteritis Education Program
The purpose of this study is to determine whether the caregivers of children presenting to
 the emergency department (ED) with acute gastroenteritis who receive extensive
 gastroenteritis education (standard education plus home nursing visit) will improve their
 gastroenteritis knowledge more than those who receive standard education (an information
 sheet) in the emergency department.
Worldwide, diarrhea remains a leading cause of childhood morbidity and mortality, with 2.5
 million deaths estimated to occur annually among children < 5 years of age. In the United
 States, acute gastroenteritis accounts for > 1.5 million outpatient visits, 200,000
 hospitalizations and approximately 300 deaths/year. The incidence of diarrhea varies between
 one and 2.5 episodes per child per year. In Ontario, children account for over 28,000
 Emergency Department visits for gastroenteritis annually, and the pediatric admission rate
 for gastroenteritis remains greater than 400/100,000. In a Toronto based report from 1978,
 viral gastroenteritis was found as the etiologic agent in the deaths of 21 children over a 5
 year period. Over 10% of patients seen at The Hospital for Sick Children ED present with
 acute gastroenteritis (vomiting, diarrhea or both). Last year over 4500 children with these
 complaints were seen.

 It has been suggested that education can improve caregiver knowledge, beliefs and practices
 related to gastroenteritis. Children of caregivers who are less knowledgeable about diarrhea,
 dehydration and oral rehydration have been found to be at increased risk for presenting to a
 hospital secondary to dehydration.

 However, it has been difficult to determine if this will translate into a reduction in
 non-urgent ED use. Very few studies have evaluated education in the ED. When it has been
 studied, they have been unsuccessful in altering ED utilization habits. One possible
 explanation for the lack of success is that some interventions have attempted to teach the
 parents while they were awaiting discharge. At that point in time, the parents are tired,
 distracted, and probably anxious to leave, thereby diminishing the effect of the
 intervention. Furthermore, providing patients with information handouts is not the optimal
 approach to achieve patient/parent education.

 This study will compare two interventions for caregivers of children with gastroenteritis:
 extensive gastroenteritis education (standard education plus home nursing visit) and standard
 education in the emergency department(an information sheet). By adding on a home health nurse
 visit 12 to 36 hours later, we hope to achieve several benefits:

 1. Increased parental knowledge regarding gastroenteritis. This includes etiology and
 prevention, signs and symptoms of dehydration, when to seek care, the appropriate use of
 oral rehydration solutions, re-feeding, and the role of medications (or lack thereof).

 2. Increased parental knowledge will hopefully translate into reduced resource use. This
 may translate into improved use for other non-acute illnesses such as fever and colds.
 Improved resource use may include a reduction in ED visits and potentially even primary
 care provider use.

 3. This may also translate into improved patient outcomes by avoiding dehydration,
 decreasing transmission and seeking medications for the illness. Fewer ED visits may
 additionally translate into fewer investigations and intravenous requirements.

 Thus we will compare improvement in caregiver knowledge of gastroenteritis and dehydration
 and number of emergency department visits at one year in the two treatment groups.
Inclusion Criteria:

 -  Caregiver of a child aged 3 months to 4 years of age, presenting to the emergency
 department with a diagnosis of gastroenteritis, which may be manifested by vomiting,
 diarrhea, or both

 -  Age > 16 years

 -  Ability to speak and read English

 Exclusion Criteria:

 -  Do not live in the metropolitan Toronto area

 -  Previously enrolled in this trial