Improving Pediatric Diabetic Ketoacidosis Management in Community Emergency Departments Using a Simulation-Based Collaborative Improvement Program
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Kamal Abulebda1, Travis Whitfill, Erin E Montgomery2
1From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN.
Insights
A simulation program improved pediatric diabetic ketoacidosis (DKA) care in community emergency departments (CEDs). The collaborative approach enhanced adherence to DKA guidelines, benefiting pediatric patient care.
Area of Science:
- Pediatric Emergency Medicine
- Medical Simulation
- Quality Improvement
Background:
- Community emergency departments (CEDs) often lack resources for pediatric diabetic ketoacidosis (DKA) care.
- This deficiency impacts the quality of care for acutely ill children.
- A simulation-based collaborative program was proposed to address these gaps.
Purpose of the Study:
- To evaluate the effectiveness of a simulation-based collaborative program.
- To improve the quality of care for pediatric DKA patients in CEDs.
- To measure adherence to DKA guidelines through simulated scenarios.
Main Methods:
- Prospective interventional study with 91 teams from 13 CEDs.
- In situ simulations in CED resuscitation bays, facilitated by an academic medical center (AMC) team.
- Adherence measured using a critical action checklist and analyzed with mixed linear regression.
Main Results:
- A 22-point improvement in overall adherence to the DKA checklist post-intervention.
- Six of nine critical checklist actions showed statistically significant improvement.
- Medium pediatric volume CEDs demonstrated the most improvement; those further from the AMC showed less.
Conclusions:
- In situ simulation-based collaborative programs significantly enhance adherence to pediatric DKA guidelines in CEDs.
- This approach offers a viable strategy for improving pediatric DKA management in resource-limited settings.
- The program demonstrated a positive impact on critical care actions for pediatric DKA.
Objectives:
The majority of pediatric patients with diabetic ketoacidosis (DKA) present to community emergency departments (CEDs) that are less prepared to care for acutely ill children owing to low pediatric volume and limited pediatric resources and guidelines. This has impacted the quality of care provided to pediatric patients in CEDs. We hypothesized that a simulation-based collaborative program would improve the quality of the care provided to simulated pediatric DKA patients presenting to CEDs.
Methods:
This prospective interventional study measured adherence of multiprofessional teams caring for pediatric DKA patients preimplementation and postimplementation of an improvement program in simulated setting. The program consisted of (a) a postsimulation debriefing, (b) assessment reports, (c) distribution of educational materials and access to pediatric resources, and (d) ongoing communication with the academic medical center (AMC). All simulations were conducted in situ (in the CED resuscitation bay) and were facilitated by a collaborative team from the AMC. A composite adherence score was calculated using a critical action checklist. A mixed linear regression model was performed to examine the impact of CED and team-level variables on the scores.
Results:
A total of 91 teams from 13 CEDs participated in simulated sessions. There was a 22-point improvement of overall adherence to the DKA checklist from the preintervention to the postintervention simulations. Six of 9 critical checklist actions showed statistically significant improvement. Community emergency departments with medium pediatric volume showed the most overall improvement. Teams from CEDs that are further from the AMC showed the least improvement from baseline.
Conclusions:
This study demonstrated a significant improvement in adherence to pediatric DKA guidelines in CEDs across the state after execution of an in situ simulation-based collaborative improvement program.
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