Dataset Information

Cohorting Dengue Patients Improves the Quality of Care and Clinical Outcome.

ABSTRACT:

Introduction

The increasing incidence of dengue among adults in Malaysia and other countries has important implications for health services. Before 2004, in order to cope with the surge in adult dengue admissions, each of the six medical wards in a university hospital took turns daily to admit and manage patients with dengue. Despite regular in-house training, the implementation of the WHO 1997 dengue case management guidelines by the multiple medical teams was piecemeal and resulted in high variability of care. A restructuring of adult dengue inpatient service in 2004 resulted in all patients being admitted to one ward under the care of the infectious disease unit. Hospital and Intensive Care Unit admission criteria, discharge criteria and clinical laboratory testing were maintained unchanged throughout the study period.

Objectives

To evaluate the impact of cohorting adult dengue patients on the quality of care and the clinical outcome in a university hospital in Malaysia.

Methods

A pre (2003) and post-intervention (2005-6) retrospective study was undertaken.

Intervention

Cohorting all dengue patients under the care of the Infectious Disease team in a designated ward in 2004.

Results

The number of patients enrolled was 352 in 2003, 785 in 2005 and 1158 in 2006. The evaluation and detection of haemorrhage remained high (>90%) and unchanged throughout the study period. The evaluation of plasma leakage increased from 35.4% pre-intervention to 78.8% post-intervention (p = <0.001) while its detection increased from 11.4% to 41.6% (p = <0.001). Examination for peripheral perfusion was undertaken in only 13.1% of patients pre-intervention, with a significant increase post-intervention, 18.6% and 34.2% respectively, p = <0.001. Pre-intervention, more patients had hypotension (21.5%) than detected peripheral hypoperfusion (11.4%), indicating that clinicians recognised shock only when patients developed hypotension. In contrast, post-intervention, clinicians recognised peripheral hypoperfusion as an early sign of shock. The highest haematocrit was significantly higher post-intervention but the lowest total white cell counts and platelet counts remained unchanged. A significant and progressive reduction in the use of platelet transfusions occurred, from 21.7% pre-intervention to 14.6% in 2005 and 5.2% in 2006 post-intervention, p<0.001. Likewise, the use of plasma transfusion decreased significantly from 6.1% pre-intervention to 4.0% and 1.6% in the post-intervention years of 2005 and 2006 respectively, p<0.001. The duration of intravenous fluid therapy decreased from 3 days pre-intervention to 2.5 days (p<0.001) post-intervention; the length of hospital stay reduced from 4 days pre- to 3 days (p<0.001) post-intervention and the rate of intensive care admission from 5.8% pre to 2.6% and 2.5% post-intervention, p = 0.005.

Conclusion

Cohorting adult dengue patients under a dedicated and trained team of doctors and nurses led to a substantial improvement in quality of care and clinical outcome.

SUBMITTER: Lum LC

PROVIDER: S-EPMC4457480 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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Publications

Cohorting Dengue Patients Improves the Quality of Care and Clinical Outcome.

Lum Lucy C S LC Syed Omar Sharifah Faridah SF Sri La Sri Ponnampalavanar Sasheela S Tan Lian H LH Sekaran Shamala Devi SD Kamarulzaman Adeeba A

PLoS neglected tropical diseases 20150605 6

<h4>Introduction</h4>The increasing incidence of dengue among adults in Malaysia and other countries has important implications for health services. Before 2004, in order to cope with the surge in adult dengue admissions, each of the six medical wards in a university hospital took turns daily to admit and manage patients with dengue. Despite regular in-house training, the implementation of the WHO 1997 dengue case management guidelines by the multiple medical teams was piecemeal and resulted in ...[more]

PMID: 26047325

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Dataset Information

Cohorting Dengue Patients Improves the Quality of Care and Clinical Outcome.

Introduction

Objectives

Methods

Intervention

Results

Conclusion

Publications

Cohorting Dengue Patients Improves the Quality of Care and Clinical Outcome.

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