Department of Endocrinology, King Fahad Armed Forces Hospital Jeddah, Ministry of Defense, General Services Directorate, Continuous Quality Improvement and Patient Safety, Kingdom of Saudi Arab
Background: DKA is a major acute metabolic complication of diabetes. Recent data indicates increase in hospitalizations worldwide during 2009 - 2014. Diabetic ketoacidosis (DKA) is one of the life-threatening acute complications of diabetes mellitus. DKA clinical pathway was approved based on most recent international evidence and guidelines and structured to be as simple and as safe as possible in the light of evidence based practices. A standard clinical practice pathway if applied in the institute for management of DKA, it will optimize the management and decrease the length of stay and substantial decrease in cost and better utilization of beds. Department of Endocrinology in cooperation with CQI&PS Department developed a pathway. The pathway aimed to facilitate evidence-based practice in managing DKA patients, provide patients with uniform care and ensure effective and safe management of DKA. DKA pathway approved by the Hospital Director and implemented as official management tool for DKA patients in 2014. To reduce the length of stay (LOS) and comparing with national and international benchmark and complication. The study carried out over 5 years, since January 2015 to December 2019
.Methods: The quality improvement methodological framework adopted in this study based on FOCUS- PDCA improvement model.
Interventions: Implementing diabetic ketoacidosis clinical pathway. Results: A total number of 576 patients admitted with a diagnosis of DKA from January 2015 to December 2019 treated with standard clinical practice pathway. DKA average length of stay per year significantly decreased from an average, 2.14 to 1.47 days, which is below the national and international benchmark. Zero mortality rate is highly outstanding in our study compared with the rates found in other studies conducted in KSA and other Europeans institutes. The impact analysis was calculating the potential gain in beds from LOS reduction comparing with the international benchmark of DKA patient with estimated cost of 2054/day and the gain in available beds by 1.6 beds per month.
Conclusion: Most DKA episodes require hospital admission, but mortality is zero, and length of stay at the ER and medical ward depends on the initial severity of the episode.
Keywords: Diabetes Mellitus; Ketoacidosis; DKA; Length of Stay
Turki Abdulaziz Al-Harthi., et al. “Sustainability of Improvement Project by Implementation of Clinical Practice Pathway (CPP): To Reduce Length of Stay, Decrease Burden of Cost and Mortality in Diabetic Ketoacidosis (DKA)”. EC Microbiology 18.5 (2022): 24-32.
© 2022 Turki Abdulaziz Al-Harthi., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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