Pediatric Type 1 Diabetes: Reducing Admission Rates for Diabetes Ketoacidosis

Abstract

Background:Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions.Methods:A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families. A before-after study was conducted comparing performance outcomes in years 2007-2010 (preintervention) to 2012-2014 (postintervention) using administrative data and Wilcoxon rank sum and Fischer exact tests.Results:DKA admissions decreased by 44% postintervention (16.7 vs 9.3 per 100 followed patient-years; P = .006), unique patient 30-day readmissions decreased from 20% to 5% postintervention (P = .001), and median LOS significantly decreased postintervention (P < .0001). Although not an original goal of the study, median hemoglobin A1C of a subset of the population transitioned from sliding scale decreased, 10.3% to 8.9% (P < .02).Conclusions:When clinical and widespread program interventions were used, significant reductions in DKA hospitalizations, 30-day readmissions, and LOS occurred for pediatric T1DM. Continuous performance improvement efforts are needed for improving DKA outcomes.

Pediatric diabetes care: inpatient care in the Maps of Health Needs of Poland in 2014

“…In four provinces, the Opole, Greater Poland, Warmia-Masuria and Kujawy-Pomerania Provinces, this proportion is at least twice as high. Again, while the reporting is correct in these provinces, it should, however, be assumed that this finding poses a challenge to these regions, their specialist pediatrics diabetes care and the improvement of the overall awareness in the society and among the primary care physicians regarding the initial manifestations of diabetes mellitus [38,39].…”

Help! I Have a Patient With Diabetes Who Is Sick!

“…Recommended guidelines include a correction dose of rapid-acting insulin via subcutaneous injection and insulin pump infusion set change. • Never miss an opportunity to educate (Crossen, Wilson, Saynina, & Sanders, 2016;Lamb et al, 2011;Renders, Valk, & Griffin, 2001)!…”

“…Consults to the pediatric primary care provider occur when a child with type 1 diabetes has an acute illness. Many caretakers of children with diabetes are unaware of recommended sick-day guidelines (Lamb, Edin, Editor, & Kemp, 2011). Many primary care nurses do not feel knowledgeable about sick-day management of type 1 diabetes (Vincent et al, 2016).…”

“…Primary care nurses reported a preference for concrete educational tools regarding diabetes self-management and sick day guidelines (Jansink, Braspenning, van der Weijden, Elwyn, & Grol, 2010). However, the lack of universally approved guidelines for sick-day management of the child with type 1 diabetes increase caretaker and primary care provider stress and confusion (Lamb et al, 2011).…”

T1D Exchange Quality Improvement Collaborative: A Learning Health System to Improve Outcomes for All People With Type 1 Diabetes

“…Quality improvement (QI) approaches have been more extensively used in type 2 diabetes than in type 1 diabetes. The relatively few previous type 1 diabetes QI publications primarily describe activities in pediatric diabetes centers and are from single sites (7)(8)(9)(10)(11). Reports in this special collection of articles (1,(12)(13)(14) highlight the value of using QI approaches within a learning network to reveal systemic barriers and health care disparities and to improve real-world outcomes.…”