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Updated: Jan 19, 2026

Movement Retraining using Real-time Feedback of Performance
Published on: January 17, 2013
Regular performance feedback may be key to maintain good quality DKA management: results from a five-year study
Punith Kempegowda1,2, Joht Singh Chandan1,3, Benjamin Coombs1
1Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Sustained improvement in diabetic ketoacidosis (DKA) management requires regular performance feedback. Without consistent feedback, DKA duration trends upward, highlighting the need for ongoing audits and reviews.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Healthcare Quality Improvement
Background:
- Diabetic ketoacidosis (DKA) management requires continuous improvement to ensure optimal patient outcomes.
- Performance feedback is hypothesized as a key driver for sustained enhancements in DKA care pathways.
Purpose of the Study:
- To evaluate the impact of regular performance feedback on diabetic ketoacidosis (DKA) management.
- To assess the sustainability of DKA management improvements following the implementation of an audit and feedback system.
Main Methods:
- A 'theory of change' approach guided the study design.
- Interventions included monthly performance feedback, a live DKA audit tool, automatic specialist referrals, electronic monitoring, and guideline redesign.
- Data were collected from DKA patients at a tertiary care center in the UK (April 2014 - March 2018).
Main Results:
- A significant reduction in DKA duration was observed post-intervention.
- The benefits of improved DKA management diminished without consistent, regular feedback, with duration trending back towards baseline.
- Trends in secondary DKA management drivers mirrored the impact of feedback consistency.
Conclusions:
- Regular audit and performance feedback are essential for maintaining improvements in diabetic ketoacidosis (DKA) management.
- Sustained quality improvement in DKA care necessitates ongoing monitoring and feedback mechanisms.
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