Diabetic ketoacidosis (DKA) represents an acute complication associated with increased morbidity, mortality, multiple readmissions, and a significant financial burden for healthcare institutions. General inpatient management of DKA may differ according to practice preference, allowing for significant variations in therapy. At our institution, the Pharmacy and Therapeutics Committee recently approved the utilization of a standardized DKA management protocol. Our purpose is to formally evaluate the use of this treatment protocol for the therapeutic management of DKA in comparison to non‐protocol management.
Patients receiving orders for continuous intravenous insulin therapy from January 1, 2012 to September 1, 2013 were retrospectively identified utilizing data derived from our patient information system. Diagnosis of DKA was confirmed via chart review in which attention was allocated to prescriber admission summaries and diagnostic laboratory parameters. Patients managed without use of the approved order set were evaluated for comparison. Clinical endpoints measured included total length of stay, intensive care unit length of stay, hours on continuous intravenous insulin therapy, incidence of resuming continuous intravenous insulin, cost per admission, and 30‐day readmission rates.
The outcomes data for 78 patients managed via the pharmacy‐driven diabetic ketoacidosis protocol was compared to data derived from 83 patients managed by standard physician orders. Mean total length of hospital stay for patients with and without DKA protocol management was 4.0 ± 2.7 days compared to 4.4 ± 4.0 days, respectively. Intensive care unit (ICU) length of stay was reduced from 43.8 hours to 35.5 hours with order set utilization. Mean number of insulin drip hours with and without protocol utilization was 12.7 hours compared to 15.1 hours. The incidence of restarting intravenous insulin, a secondary measure of successful transition among levels of care, experienced a reduction with order set use compared to general management as 1.3% versus 4.8% of patients required re‐initiated of intravenous insulin therapy. Clinical endpoint reductions were translated into a significant reduction in cost of care, as the qualified average observed cost per diabetic ketoacidosis admission decreased from $6723.43 to $5084.00. Additional analyses were performed to approximate all‐cause 30‐day readmission rates and incidence of in‐house mortality. All‐cause 30‐day readmissions were significantly reduced in the intervention group (26.9% versus 9.38%) and the rate of in‐house mortality was decreased from 6% to 0% in the intervention group.
As evidenced by this initiative, the implementation of a standardized DKA management protocol resulted in an overall benefit in all measured endpoints, providing advantages in both clinical parameters and cost‐containment strategies.
To cite this abstract:Janakiram A, Massie N, Sikanderkhel S, Balouch M, Bajwa R, Monga B, Panchavati P, Edwards J, Anderson A. Impact of Standardizing the Therapeutic Management of Diabetic Ketoacidosis Patients in a Community Hospital. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 114. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/impact-of-standardizing-the-therapeutic-management-of-diabetic-ketoacidosis-patients-in-a-community-hospital/. Accessed May 23, 2019.