PT - JOURNAL ARTICLE AU - Punith Kempegowda AU - Ben Coombs AU - Peter Nightingale AU - Joht Singh Chandan AU - Jaffar Al-Sheikhli AU - Bhavana Shyamanur AU - Kasun Theivendran AU - Anitha Vijayan Melapatte AU - Umesh Salanke AU - Mohammed Akber AU - Sandip Ghosh AU - Parth Narendran TI - Regular and frequent feedback of specific clinical criteria delivers a sustained improvement in the management of diabetic ketoacidosis  AID - 10.7861/clinmedicine.17-5-389 DP - 2017 Oct 01 TA - Clinical Medicine PG - 389--394 VI - 17 IP - 5 4099 - http://www.rcpjournals.org/content/17/5/389.short 4100 - http://www.rcpjournals.org/content/17/5/389.full SO - Clin Med2017 Oct 01; 17 AB - Efficient management of diabetic ketoacidosis (DKA) improves outcomes and reduces length of stay. While clinical audit improves the management of DKA, significant and sustained improvement is often difficult to achieve. We aimed to improve the management of DKA in our trust through the implementation of quality improvement methodology. Five specific targets (primary drivers: fluid prescription, fixed rate intravenous insulin infusion, glucose measurement, ketone measurement and specialist referral) were selected following a baseline audit. Interventions (secondary drivers) were developed to improve these targets and included monthly feedback to departments of emergency medicine, acute medicine, and diabetes. Following our intervention, the mean average duration of DKA reduced from 22.0 hours to 10.2 hours. We demonstrate that regular audit cycles with interventions introduced through the plan-do-study-act model is an effective way to improve the management of DKA.