Strategies to improve adherence to interventions {11c}
infectious disease, hyperhydration
INFECTIOUS DISEASE, EVENTS
Site investigators and champions at each site, which include a pediatric emergency medicine physician, nephrologist, pediatric hospital medicine specialist, and at certain sites a gastroenterologist, and/or infectious disease specialist, will be responsible for educating all relevant individuals (at the participating site and in their catchment/referral area) including attending physicians and trainees regarding the treatment pathways. All pathway eligible children will be monitored in real-time, and support will be provided to the clinical care team regarding pathway adherence which has been facilitated through the building and implementation of clinical care order sets embedded into the electronic medical record (EMR) at participating sites.For each patient, the EMS (emergency medical services) Data Center (EDC, Salt Lake City, UT) will classify the amount of fluid administered in relation to their target as defined by the pathway to which the site has been allocated. Adherence at an individual patient level will be reviewed during weekly leadership team meetings and those cases where participants met our study definition of non-adherence (> 110% and < 175% maintenance fluids in the conservative fluid management and hyperhydration groups, respectively) will undergo review to identify potential etiologies and solutions in an attempt to mitigate future such events.