Effect of an evidenced-based diabetic ketoacidosis pathway in a pediatric emergency department on patient outcomes

Abstract Purpose: Our primary objective was to measure time to first insulin dose, before and after usage of a diabetic ketoacidosis (DKA) order set in a pediatric emergency department. We had multiple secondary objectives, including determining the relation of patient outcomes to time to first insulin (such as their length of stay in the ED, as well as inpatient admissions as a whole), and improving time to resolution of all DKA patients. Methods: This project was implemented after an agreement between the Endocrine and Emergency Departments that the establishment of a guideline would be helpful; the ICFISH pathway was created and implemented. ICFISH is an acronym for identify, call endocrinology, fluids, insulin, status, and finally hand-off. The retrospective data collection occurred between October 1, 2014 and March 31, 2016. The prospective data collection was between November 1, 2016 and June 8, 2017. All patients admitted for DKA during this time frame were included, but patients with new-onset diabetes and transfer patients were excluded from analyses. Patient records were entered into REDCap and analyses were performed via SAS (Statistical Analysis Software). Time to resolution, length of stay, whether the patient was discharged from the ED, and whether patient was admitted to PICU were compared based on whether the patient was admitted before or after ICFISH implementation. Results: A total of 198 patients met inclusion criteria, and 127 were excluded, leaving 71 patients. There was a statistically significant decrease in the time to resolution of patients on the floor or PICU from the pre-group to the post-group (p=0.032), as well as length of stay (p=0.004), ED discharge (p=0.028), and PICU admission (p=0.001). Conclusion: A standardized order set to treat patients admitted for DKA, via the ICFISH pathway, leads to decreased variability, thus resulting in shorter length of stay in the hospital overall, decreased PICU admissions, and increased ED discharge. Research Area Cook Children’s Medical Center Presentation Type Poster