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BACKGROUND: Guidelines for preventing and treating acute gastroenteritis (AGE) have generally not been incorporated into medical practice. An evidence-based clinical practice guideline was adapted from national guidelines to meet the practice styles characterizing care in southwestern Ohio and implemented at the Children\'s Hospital Medical Center (Cincinnati). Its efficacy was assessed in terms of emergency department (ED) encounters and admissions, mean and total hospital costs, and mean length of hospitalization.
METHODS: Comparisons were made between patients seen during peak gastroenteritis months (December-May) before (fiscal year [FYs] 1994-1997) and after (FYs 1998 and 1999) guideline implementation. Data were extracted from hospital charts, clinical databases, and billing records.
RESULTS: Following implementation, mean yearly ED encounters for AGE decreased 22% and mean yearly admissions decreased 33%. The percentage of admitted children with minor illness decreased (p = 0.002). Mean length of stay decreased 21% for children with minor illness (p = 0.0001) and 5% for others. Hydration status was noted in only 15% of ED charts examined but increased to 63% in FY 1998 and 86% in FY 1999 (p < 0.001). The proportion of admitted patients who advanced to a regular diet by discharge increased from 4.9% (FY 1997) to 23% (FY 1998) and 76% (FY 1999; p < 0.0001). Total inpatient days/year decreased by 43%. Mean hospital costs did not change significantly.
CONCLUSIONS: Following implementation, fewer patients with AGE were seen in the ED and fewer were admitted to the hospital for care. Hospital stays were shorter, and children were more likely to resume their diets before discharge.

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BACKGROUND: The aim of this study is to evaluate the advantages as well as the difficulties resulting from the introduction of WHO guidelines for the treatment of acute diarrhoea in Albania.
METHODS: The study was carried out at the Department of Paediatrics, Tirana, Albania. To evaluate the changes in case fatality and duration of hospital stay the clinical course of 226 children admitted for acute diarrhoea during a 1-month period was compared with the course of 235 children admitted for an equivalent period, prior to the introduction of World Health Organisation (WHO) guidelines. A detailed prospective study of 43 children admitted for acute diarrhoea with moderate (28 cases) or severe (15 cases) dehydration, managed according to WHO guidelines, was also carried out to identify problems arising from the new approach.
RESULTS: The case fatality ratio was lower (0.44% versus 1.27%) and the mean duration of hospital stay shorter (4.8 versus 5.5 days) after the introduction of WHO guidelines. In 35% (10/28) of cases with moderate dehydration, the oral rehydration therapy failed to improve the hydration status, leading to the need of i.v. treatment. Failures in the Oral Rehydration Solution (ORS) group were always due to the insufficient intake of fluids, in the majority of cases because mothers were not administering it properly.
CONCLUSIONS: The introduction of WHO Guidelines for diarrhoea case-management was beneficial. To obtain better compliance in giving ORS to moderately dehydrated children, appropriate training of nursing staff, together with better communication and support to mothers admitted with their child are necessary.

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