Rapid Adoption of Lactobacillus rhamnosus GG for Acute Gastroenteritis

An evidence-based practice change was implemented in six weeks of project launch and sustained for seven months.

Acute gastroenteritis (AGE) affects a third of children under age 3 who are unvaccinated or infected with other viruses. To treat the severe diarrhea, patients historically receive just oral rehydration. Despite evidence that probiotics such as Lactobacillus rhamonosus GG (LGG) reduce the duration of diarrhea, few patients (1%) admitted to the hospital are routinely prescribed it.

Investigators at the Cincinnati Children’s Hospital Medical Center wanted to quickly increase the  percentage of children with AGE who are given LCC to 90 percent within 120 days.

To do that, they engaged a multidisciplinary team that included physicians, nurses, and a quality improvement coach, as well as representatives of the evidence-based guideline development group to apply the Rapid Cycle Improvement Collaborative method. The team mapped processes, identified key drivers of LGG use, and developed interventions to promote LGG use. They educated key stakeholders and also made sure that adequate doses of LGG were available in hospital locations. Further, they updated the existing gastroenteritis order set in the electronic medical record.

As a result of their efforts, prescription of LGG at admission for children with AGE increased to 100 percent within six weeks of the project’s beginning. That rate of prescribing has been sustained for seven months.