Reducing resident errors on an inpatient diabetes pathway

OBJECTIVEdDiabetes errors, particularly insulin administration errors, can lead to compli-cations and death in the pediatric inpatient setting. Despite a lecture-format curriculum ondiabetes management at our children’s hospital, resident diabetes-related errors persisted. Wehypothesizedthatamultifaceted,learner-centereddiabetescurriculumwouldhelpreducepath-way errors.RESEARCH DESIGN AND METHODSdThe 8-week curricular intervention consistedof 1) an online tutorial addressing residents’ baseline diabetes management knowledge, 2)aninteractive diabetes pathway discussion, 3) a learner-initiated diabetes question and answersession,and4)acasepresentationfeaturingembeddedpathwayerrorsforresidentstorecognize,resolve, and prevent. Errors in the 9 months before the intervention, as identified through anincident reporting system, were compared with those in the 10 months afterward, with errorsclassified as relating to insulin, communication, intravenous fluids, nutrition, and dischargedelay.RESULTSdBeforethecurricular intervention, resident errorsoccurred in28patients(19.4% of144 diabetes admissions) over 9 months. After the intervention, resident errors occurred in 11patients (6.6% of 166 diabetes admissions) over 10 months, representing a statistically significant(P=0.0007)decreaseinpatientswitherrorsfrombeforeinterventiontoafterintervention.Through-out the study, the errors were distributed into the categories as follows:insulin,43.8%; communi-cation, 39.6%; intravenous fluids, 14.6%; nutrition, 0%; and discharge delay, 2.1%.CONCLUSIONSdAn interactive learner-centered diabetes curriculum for pediatric resi-dents can be effective in reducing inpatient diabetes errors in a tertiary children’s hospital. Thiseducational model promoting proactive learning has implications for decreasing errors acrossother medical disciplines.