AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSION: The ICP significantly improved key areas in the management of DKA, although there remains room for further improvements.
AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSION: The ICP significantly improved key areas in the management of DKA, although there remains room for further improvements.
Authors: Christopher M Horvat; Heba M Ismail; Alicia K Au; Luigi Garibaldi; Nalyn Siripong; Sajel Kantawala; Rajesh K Aneja; Diane S Hupp; Patrick M Kochanek; Robert Sb Clark Journal: Pediatr Diabetes Date: 2018-04-26 Impact factor: 4.866
Authors: Susan Baxter; Maxine Johnson; Duncan Chambers; Anthea Sutton; Elizabeth Goyder; Andrew Booth Journal: BMC Health Serv Res Date: 2018-05-10 Impact factor: 2.655