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Diabetic Ketoacidosis Management in the Emergency Department

Implementation of a Protocol to Reduce Variability and Improve Safety

Griffey, Richard T.; Schneider, Ryan M.; Malone, Nora; Peterson, Charlie; McCammon, Craig

doi: 10.1097/JHQ.0000000000000211
Original Article

ABSTRACT Emergency departments (EDs) are the primary venue for diagnosis and initiation of treatment of diabetic ketoacidosis (DKA). Typically managed in an intensive care unit (ICU), in many medical centers, limited ICU bed availability necessitates DKA-extended ED management until sufficient improvement for admission to a non-ICU bed. Although DKA treatment is well established, coordinating safe and effective extended care in a busy ED is complex. Recurrent problems in this high-risk transition of care led us to improvement efforts. We studied the impact of a standardizing ED DKA management in two phases: rollout of a DKA pathway in our computerized order entry system followed by audit and feedback. We evaluated adherence, clinical process, operational, and safety measures following these interventions. Adherence to the pathway was initially slow, improving significantly after audit and feedback. We observed mixed improvements in clinical processes, no changes in operational metrics (as expected), and reductions in variability for several measures. There were no deteriorations and improvements in measures of safety, and a reduction in the number of adverse event reports in the postimplementation periods.

For more information on this article, contact Richard T. Griffey at

Funders: This work was supported by grant# P30DK092950 from the NIH/NIDDK through the Washington University Center for Diabetes Translation Research Pilot and Feasibility Program. Dr. Griffey is also supported by grant R18 HS025052-01 from the Agency for Healthcare Research and Quality, and grants #3767 and #4442 from the Barnes Jewish Hospital Foundation. The contents of this work are solely the responsibility of the authors and do not necessarily represent the official view of the AHRQ, WU-CDTR, NIDDK, NIH, or the BJHF.

The authors declare no conflicts of interest.

© 2019 National Association for Healthcare Quality
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