A child suffering from acute abdominal pain may receive notably different care based on where he or she is taken for medical attention. This is a finding at the heart of a new study by the PCHSS’ Associate Professor Yvonne Zurynski, Professor Jeffrey Braithwaite and colleagues — in collaboration with CareTrack Kids—published in BMJ Quality & Safety.
In “Quality of care for acute abdominal pain in children”, the visits to general practitioners, emergency departments, and hospitals of 514 children experiencing acute abdominal pain were examined. The care they received was analysed against evidence- or consensus-based clinical practice guidelines, which are generally accepted as “central in supporting care quality and safety.”
Overall, the rate of adherence to established best practices was ~70% (based on 21 care quality indicators). Compared to the Australian health system overall, this is not such a poor result. Other studies have found that guidelines tend to be followed around 60% of the time, which contributes to an array of problems related to overtreatment, overdiagnosis, and low-value care.
Still, there’s plenty of room for improvement in this area, particularly when the diversity of care provided across different healthcare settings is taken into account: Care in general practice settings had significantly lower rates of adherence to guidelines (~63%) than in emergency departments (86%) and in hospital inpatient settings (~88%).
The authors point to a number of factors that may contribute to the significantly lower adherence rates in general practices, such as “limited time, seeing children infrequently and limited decision support and clinical governance structures”, as well as the fact that “GPs see over 160 different conditions in their daily practice”.
To improve adherence rates in general practices and all healthcare settings, the authors suggest increased use of electronic decision support tools to embed clinical recommendations into everyday practice. In turn, they say, such tools could be supported data gathered through systems for routine data collection, including by taking full advantage of the potential of electronic health records.
Zurynski Y, Churruca K, Arnolda G, Dalton S, Ting HP, Hibbert PD, Molloy C, Wiles LK, de Wet C, Braithwaite J. Quality of care for acute abdominal pain in children. BMJ Quality & Safety, Published Online First: 27 November 2019. doi: 10.1136/bmjqs-2019-010088