RT Journal Article
SR Electronic
T1 Regular and frequent feedback of specific clinical criteria delivers a sustained improvement in the management of diabetic ketoacidosis 
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 389
OP 394
DO 10.7861/clinmedicine.17-5-389
VO 17
IS 5
A1 Punith Kempegowda
A1 Ben Coombs
A1 Peter Nightingale
A1 Joht Singh Chandan
A1 Jaffar Al-Sheikhli
A1 Bhavana Shyamanur
A1 Kasun Theivendran
A1 Anitha Vijayan Melapatte
A1 Umesh Salanke
A1 Mohammed Akber
A1 Sandip Ghosh
A1 Parth Narendran
YR 2017
UL http://www.rcpjournals.org/content/17/5/389.abstract
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.