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Authors: Bashar Elwir , Patrick Ukwade , Ayesha Almemari

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Abstract

Background: Intravenous (IV) fluids are a commonly prescribed treatment in the emergency department (ED). Often the prescription of a treatment to be administered in the ED prolongs the patients' length of stay (LOS). We hypothesize that IV fluids are overprescribed in the ED, mainly in patients classified as Emergency Severity Index (ESI) triaged level 3 (T3) and level 4 (T4). Methods: We conducted a quality audit to assess the appropriateness of IV fluid use in adult (age > 16 years) hemodynamically (HD) stable ESI triaged T3 and T4 patients at a tertiary hospital ED during two 6-month periods. Appropriate use of IV fluids was defined from the published literature and our own clinical experience. The primary outcome looked at was the number of patients appropriately prescribed IV fluids before and after implementing a list of indications for IV fluid use in HD stable patients. Results: Analysis showed 62.8% of T3 triaged patients and 74.2% of T4 patients were inappropriately prescribed IV fluids before the implementation of our indication list. This compared similar to 63.6% of T3 triaged patients and 71.4 % of T4 triaged patients after implementation. Median LOS of patients who received IV fluids was 3.5 and 3 hours for T3 and T4 patients, respectively. Conclusion: The data obtained in this quality audit demonstrated no difference in the use of IV fluids before and after implementing a list of indications for fluid therapy in HD stable T3 and T4 patients in our ED. We believe that developing a structured education program for caregivers in addition to patient education may help improve utilization of IV fluid based on true clinical indication.

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Keywords: Intravenous fluid administration, emergency departments, triage, overcrowding, length of stay

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