Diabetic Ketoacidosis Management in the Emergency Department: Implementation of a Protocol to Reduce Variability and Improve Safety

Griffey, Richard T.; Schneider, Ryan; Malone, N.; Peterson, Charlie A.; McCammon, Craig

doi:10.1097/jhq.0000000000000211

Cited by 3 publications

(4 citation statements)

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“…7 Similarly, Griffey et al found that the implementation of audit and feedback in addition to electronic implementation of the DKA pathway was required to improve clinical care. 8 It is essential that the DKA/HHS insulin infusion protocol be easily accessed and read. This is particularly important for nursing and medical staff faced with time pressures.…”

Section: Discussionmentioning

confidence: 99%

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DKA/HHS insulin infusion protocol adherence and patient outcomes in Shellharbour Hospital

Khor

Mohiuddin

2023

Internal Medicine Journal

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BackgroundDiabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are medical emergencies requiring prompt assessment and management to avoid complications.AimsTo examine adherence to the hospital DKA/HHS insulin infusion protocol, assess outcomes in patients admitted with DKA or HHS, and determine if improvements have been observed from a similar audit in 2016.MethodsAn audit was conducted on 40 patients admitted to Shellharbour Hospital with DKA or HHS. Protocol adherence was assessed in the domains of fluid replacement, potassium replacement, use of the correct insulin infusion schedule, timing of commencement of dextrose infusion and appropriate transition to subcutaneous insulin. The outcomes assessed included length of hospital stay, duration of insulin infusion, time to euglycaemia, intensive care unit (ICU) transfer, overlap between insulin infusion and subcutaneous insulin, diabetes team review and incidence and management of hypoglycaemia.ResultsThe proportion of cases that adhered to the components of the insulin infusion protocol is as follows: fluid replacement (40%), potassium replacement (72.5%), correct insulin schedule (82.5%), appropriate commencement of intravenous dextrose (80%) and appropriate transition to subcutaneous insulin (87.5%). Appropriate overlap between insulin infusion and subcutaneous insulin occurred in 62.5% of patients. Eighty‐five per cent of patients were reviewed by the diabetes team. Three per 40 patients experienced hypoglycaemia, and none of the three patients was treated as per protocol. Compared to the 2016 audit, there was a significant improvement in potassium replacement but a decrease in appropriate fluid replacement.ConclusionThis audit highlights areas in DKA/HHS management requiring improvement. These include fluid and potassium replacement and appropriate overlap between subcutaneous insulin and insulin infusion.

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Section: Discussionmentioning

confidence: 99%

“…Similarly, Griffey et al . found that the implementation of audit and feedback in addition to electronic implementation of the DKA pathway was required to improve clinical care 8 …”

Section: Discussionmentioning

confidence: 99%

DKA/HHS insulin infusion protocol adherence and patient outcomes in Shellharbour Hospital

Khor

Mohiuddin

2023

Internal Medicine Journal

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“…Management of critically ill ED patients that incorporates the nuances of resuscitation and emphasizes a systematic approach to critical care is associated with improved outcomes 13–19 . The resuscitation and emergency critical care (RECC) fellowship was developed to improve and promote this systematic approach.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11][12] Management of critically ill ED patients that incorporates the nuances of resuscitation and emphasizes a systematic approach to critical care is associated with improved outcomes. [13][14][15][16][17][18][19] The resuscitation and emergency critical care (RECC) fellowship was developed to improve and promote this systematic approach. The purpose of this paper is to inform the medical community of this newly established pathway and provide a blueprint for the development of future RECC programs.…”

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confidence: 99%

Blueprint for the development of resuscitation and emergency critical care fellowships

Bracey,

Tichauer,

et al. 2023

AEM Education and Training

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The volume of critically ill patients presenting to the emergency department (ED) is increasing rapidly. Continued growth will likely further stress an already strained U.S. health care system. Numerous studies have demonstrated an association with worsened outcomes for critically ill patients boarding in the ED. To address the increasing volume and complexity of critically ill patients presenting to EDs nationwide, resuscitation and emergency critical care (RECC) fellowships were developed. RECC programs teach a general approach to the management of the undifferentiated critically ill patient, advanced management of critically ill patients by disease presentation, and ongoing supportive care of the critically ill patient boarding in the ED. The result is critical care training beyond that of a typical emergency medicine (EM) residency with a focus on the unique features and challenges of caring for critically ill patients in the ED not normally found in critical care fellowships. Graduates from RECC fellowships are well suited to practicing in any ED practice model and may be especially well prepared for EDs that distinguish acuity between zones (e.g., resuscitative care units, ED‐based intensive care units). In addition to further developing clinical acumen, RECC fellowships provide graduates with a niche in EM education, research, and administration. In this article, we describe the philosophical principles and practical components necessary for the creation of future RECC fellowships.

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The Development and Validation of a Mobile Application for Guidance for Management of Severe Diabetic Ketoacidosis

Mendpara¹,

Bajpai²,

Patel³

et al. 2022

Indian J Pediatr

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Diabetic Ketoacidosis Management in the Emergency Department: Implementation of a Protocol to Reduce Variability and Improve Safety

Cited by 3 publications

References 11 publications

DKA/HHS insulin infusion protocol adherence and patient outcomes in Shellharbour Hospital

DKA/HHS insulin infusion protocol adherence and patient outcomes in Shellharbour Hospital

Blueprint for the development of resuscitation and emergency critical care fellowships

The Development and Validation of a Mobile Application for Guidance for Management of Severe Diabetic Ketoacidosis

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