TOP 54 - Improving Classification of Dehydration in Pediatric Patients Using a Standardized Scale

Publication Number: 2806.TOP 54

Nisha Altaf Qazi, State University of New York Downstate Medical Center College of Medicine, Hackensack, NJ, United States; Saema H. Khandakar, SUNY Downstate College of Medicine, Albertson, NY, United States; Haram Abdelmajid, SUNY Downstate medical center, Brooklyn, NY, United States; Huong Tran, State University of New York Downstate Medical Center College of Medicine, New York, NY, United States; Ekemini Ufot, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Subashini Azhagappa, SUNY Downstate medical center, Brooklyn, NY, United States; Nguyen Hai Nam Pham, SUNY Downstate HSU, Brooklyn, NY, United States; Himaad Hullur, State University of New York Downstate Medical Center College of Medicine, New York, NY, United States

Background: Dehydration is a frequent cause of pediatric hospital admissions and contributes to increased morbidity and mortality when not accurately assessed. Determining the degree of dehydration is essential for guiding appropriate treatment and preventing complications. At our institution, the classification of dehydration was inconsistently documented in the electronic medical record (EMR), and standardized use of a validated scale was limited.

Objective: The goal of this quality improvement (QI) project was to increase the EMR documentation of dehydration classification using the Gorelick 10-point scale from 50% to 80% among patients aged 1 month to 5 years admitted to the pediatric inpatient unit.

Design/Methods: This single-center, prospective QI study was conducted in the general pediatric inpatient unit of an urban hospital. Pre-intervention data were collected from November 2024 to January 2025 and post-intervention data from February to October 2025. Using the Model for Improvement framework, our multidisciplinary team implemented sequential Plan-Do-Study-Act (PDSA) cycles, including: (1) resident education sessions, (2) reinforcement during daily rounds, (3) visual reminders, and (4) EMR documentation templates.
The primary outcome measure was the percentage of patients with documented dehydration classification, i.e. mild, moderate or severe (Fig:1&2). The secondary outcome was length of stay (LOS). The process measure was documented use of the Gorelick scale for dehydration (Fig:3), and the balancing measure was escalation to the pediatric intensive care unit (PICU) within 4 hours of admission. Data were analyzed monthly using statistical process control charts.

Documentation of classification of dehydration
Outcome measure (Fig:1)

Classification of dehydration of all admitted patients
(Fig:2)

Percent Use of Gorelick Scale for classifying dehydration
Process measure (Fig:3)