Standardized Hospital Management of Pediatric Diabetic Ketoacidosis Reduces Frequency of Low Blood Glucose Episodes

BACKGROUND Treatment of diabetic ketoacidosis (DKA) carries the risk of hypoglycemia. At baseline, 32% of our patients treated for DKA had a BG<80mg/dL. We hypothesized standardized DKA management with a two-bag IV fluid system would reduce our hospital-wide frequency of BG<80 mg/dL. OBJECTIVE In patients treated for DKA, decrease the rate of visits experiencing one or more BG<80mg/dL by 10% within 24 months. METHODS Plan-do-study-act cycles tested interventions linked to key drivers including: standardized DKA guidelines incorporating a two-bag fluid system, efficient ordering process, and care team education. Inclusion criterion: treatment for DKA with a bicarbonate value (HCO3) <15mEq/L. PRIMARY OUTCOME the percent of patient visits experiencing a BG<80mg/dL while undergoing treatment for DKA. Process measures included: order panel and order set utilization rates. Balancing measures included: emergency department and hospital lengths of stay, time to acidosis resolution (time to HCO3≥17mEq/L), and admission rates. Outcomes were analyzed using statistical process control charts. RESULTS From January 2017 through May 2021, our institution treated 288 different patients during 557 visits for suspected DKA. Following our interventions, the overall percent of patient visits with a BG <80mg/dL improved from 32% to 5%. The team did see small improvements in emergency department and hospital lengths of stay; otherwise, there was no significant change in our balancing measures. CONCLUSIONS Use of quality improvement methodology and standardized DKA management resulted in a significant reduction of BG<80mg/dL in patients treated for DKA. This article is protected by copyright. All rights reserved.