Does an integrated care pathway enhance the management of diabetic ketoacidosis?

Integrated Care Pathways (ICPs) are management plans that indicate the sequence and timing of the optimal treatment for individuals with a given disorder. The treatment of diabetic ketoacidosis (DKA) before and after the implementation of an ICP in a teaching hospital was examined.

Twenty-seven episodes of DKA were identified during the 13-month control period and 22 in the 13 months following implementation of the ICP. Case notes were reviewed and relevant clinical data extracted.

The introduction of the ICP was associated with a reduction in the time taken to initiate intravenous fluid [45.0 (5-225) min to 37.5 (0-135) min; P = 0.01]. Time taken to initiate insulin infusion was also reduced [60.0 (5-755) min to 37.5 (0-175) min; P = 0.02]. The proportion of patients commenced on intravenous insulin within 60 min increased from 48 to 77% (P = 0.04). In addition, there was a reduction in the prescription of antibiotics (48-18%; P = 0.028) and low molecular weight heparin (59-5%; P < 0.001). Length of stay was not affected.

The ICP significantly improved key areas in the management of DKA, although there remains room for further improvements.