Reducing Diabetic Ketoacidosis Readmissions with a Hospital-School-Based Improvement Partnership

Area of Science:

• Pediatrics
• Endocrinology
• Diabetes Management

Background:

• Diabetic ketoacidosis (DKA) is a major cause of illness and death in children with type 1 diabetes mellitus (T1D).
• A significant majority of DKA readmissions (76.4%) were linked to missed basal insulin doses.
• Identifying and addressing missed basal insulin is critical for preventing recurrent DKA hospitalizations.

Purpose of the Study:

• To implement and evaluate a quality improvement initiative aimed at reducing DKA readmissions in pediatric T1D patients.
• To investigate the effectiveness of a standardized intervention involving school-based nurses and insulin degludec for managing basal insulin adherence.
• To assess the impact of this intervention on the rate of DKA readmissions.

Main Methods:

• Quality improvement tools were employed to design and implement process changes focused on basal insulin management.
• The intervention specifically utilized insulin degludec and engaged school-based nurses to address missed basal insulin dosing.
• Data on DKA readmission rates were collected and analyzed before and after the intervention period.

Main Results:

• The DKA readmission rate decreased by 31%, from an average of 5.25 per month to 3.64 per month.
• This reduction was observed over an 11-month intervention period (May 2019 to March 2020).
• The intervention demonstrated a significant decrease in DKA readmissions attributed to missed basal insulin.

Conclusions:

• A standardized approach incorporating school-based nursing support and insulin degludec effectively reduces DKA readmissions in pediatric T1D.
• This intervention is a safe and effective strategy for improving basal insulin adherence and lowering hospitalization rates.
• The findings highlight the importance of targeted interventions in managing chronic conditions like T1D in pediatric populations.