Regular performance feedback may be key to maintain good quality DKA management: results from a five-year study

Abstract

ObjectivesWe postulate that performance feedback is a prerequisite to ensure sustained improvement in diabetic ketoacidosis (DKA) management.DesignThe study was based on ‘theory of change’ concept that suggests changes of primary drivers determine the main outcome. A set of secondary drivers can be implemented to achieve improvements in these primary drivers and thus the main outcome.SettingThis study was conducted at a large tertiary care center in the West Midlands, UK. The region has above average prevalence of diabetes and DKA admissions in the country.ParticipantsAll participants diagnosed with DKA as per national guidelines, except those managed in intensive care unit from April 2014 to March 2018, were included in this study.InterventionsMonthly feedback of performance was the main intervention. Development of a real-time live DKA audit tool, automatic referral system of DKA to the specialist team, electronic monitoring of blood gas measurements and education and redesigning of local (trust) guidelines were the other interventions in this study.Main outcome measuresTotal DKA duration, appropriateness of fixed rate intravenous insulin infusion, fluid prescription, glucose monitoring, ketone monitoring and referral to specialists.ResultsThere was a significant reduction in the duration of DKA postintervention compared with baseline results. However, in the absence of regular feedback, the duration of DKA showed an upward trend nearing baseline values. Similar trends were noted in secondary drivers influencing DKA duration.ConclusionBased on these results, we recommend regular audit and feedback is required to sustain improvements in DKA management.

Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

“…During this time period, multiple changes to DKA management have been implemented in our hospital trust as part of an ongoing quality improvement. 32 33 These interventions have been effective at reducing DKA duration and have included development of a real-time audit tool, automatic referral to a specialist team, electronic surveillance of blood gas results, education and redesigning of local guidelines, and monthly feedback meetings. Nevertheless, an increase in length of hospitalization was seen which contradicts reports from other centers.…”

Anǭlise da estrutura de servi��os de saǧde para o cuidado ��s pessoas com diabetes

“…Ainda nos critérios de organização da assistência, observou-se a deficiência na "avaliação de desempenho", em especial, dos enfermeiros e de outros profissionais não médicos. A literatura mostra que o feedback contínuo é uma importante ferramenta de gestão da prática clínica relacionado ao DM (14) . Do mesmo modo, o critério "incentivo às boas práticas" esteve presente em 63,3% das unidades de saúde.…”

“…Nesse sentido, pode-se observar que a melhoria da estrutura dos serviços representada pela disponibilidade de prontuário eletrônico nas unidades não foi garantia de qualificação de processos de organização e gestão do cuidado, uma vez que estas dependem da adesão dos profissionais, portanto de investimento da gestão em capacitação, supervisão e feedback contínuos (14,17) .…”

Retrospective validation of Digital Evaluation of Ketosis and Other Diabetes Emergencies (DEKODE) algorithm: automated auditing system for diabetic ketoacidosis (DKA) management

“…1 Regular auditing and performance feedback are key to achieving sustained and significant improvement in the management of DKA. 2,3 One of the major limitations for maximal impact of an audit is the delay from initiation to results as the latter may not be applicable to the then current practice. In order to overcome this, our department of diabetes collaborated with the hospital's health informatics team and created an automated auditing system called Digital Evaluation of Ketosis and Other Diabetes Emergencies (DEKODE).…”