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A Quality Initiative Reducing Adverse Outcomes in Pediatric Patients with DKA During Intrafacility Transit
Michael J Stoner1,2, Kelli S Burkey2, Daniel M Cohen1,2
1Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
Insights
This quality improvement project enhanced blood glucose monitoring for children with diabetic ketoacidosis (DKA) in the emergency department (ED). Utilizing electronic health records, monitoring compliance increased to over 90%, preventing hypoglycemia.
Area of Science:
- Pediatric Endocrinology
- Quality Improvement Science
- Health Informatics
Background:
- Diabetic ketoacidosis (DKA) treatment necessitates vigilant blood glucose monitoring to avert severe complications.
- This project focused on optimizing blood glucose assessment timeliness for pediatric DKA patients during emergency department (ED) to inpatient unit transitions.
- The initiative aimed to enhance the frequency of blood glucose checks within 30 minutes prior to transfer for children receiving insulin therapy.
Purpose of the Study:
- To improve the rate of blood glucose monitoring within 30 minutes before transitioning pediatric patients with DKA from the ED to an inpatient setting.
- To reduce the incidence of hypoglycemia in pediatric DKA patients undergoing continuous insulin infusion.
Main Methods:
- A multidisciplinary team implemented a series of Plan-Do-Study-Act (PDSA) quality improvement cycles.
- The electronic health record (EHR) system was leveraged to create prompts and direct clinical staff for timely blood glucose monitoring.
- Key performance indicators included the percentage of patients with blood glucose levels checked within 30 minutes of ED departure and the occurrence of hypoglycemia.
Main Results:
- From March 2015 to November 2017, 640 pediatric DKA patients were managed in the ED, with 629 admitted for continuous insulin infusion.
- Blood glucose monitoring compliance within 30 minutes of transition increased from 56% to over 90% following PDSA cycle implementation.
- No hypoglycemia events were reported after the final PDSA cycle was implemented.
Conclusions:
- Leveraging EHR functionalities significantly improved adherence to International Society for Pediatric and Adolescent Diabetes guidelines for blood glucose monitoring during care transitions.
- The implemented system demonstrated rapid, sustained improvements in monitoring compliance.
- This quality improvement initiative is considered easily replicable, cost-effective, and enhances patient safety.
Introduction:
Treatment of diabetic ketoacidosis (DKA) requires close and timely monitoring to prevent serious adverse events. This quality improvement project details how our institution improved blood glucose monitoring around hospital admission. The project aimed to increase the blood glucose assessments for children with DKA receiving insulin in the emergency department (ED) within 30 minutes before transitioning to an inpatient unit.
Methods:
We implemented a series of Plan-Do-Survey-Act (PDSA) cycles established by a multidisciplinary team for this project, with the primary outcome of obtaining the blood glucose level within 30 minutes before leaving the ED and secondarily preventing episodes of hypoglycemia. These PDSAs harnessed the electronic health record, to prompt and direct the medical staff, to improve blood glucose monitoring.
Results:
From March 2015 to November 2017, we saw 640 patients in our ED for DKA. Of these, we admitted 629 to the inpatient unit with treatment that included continuous infusion of insulin. Over this period, we increased blood glucose monitoring for these patients within 30 minutes before the transition from 56% to >90%. Following the final PDSA cycle, we observed no reported episodes of hypoglycemia.
Conclusion:
Using the functionality of the electronic health record, we showed significant, rapid, and sustained increases in compliance with the International Society for Pediatric and Adolescent Diabetes guideline by alerting ED staff caring for patients receiving continuous insulin around the time of care-team transitions. We believe that this program is easily replicable, cost-effective, and safety enhancing.
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