TITLE:
The Impact of a Structured Clinical Pathway on the Application of Management Standards in Patients with Diabetic Ketoacidosis and Its Acceptability by Medical Residents
AUTHORS:
Imad S. Hassan, Azzam D. Al-Otaibi, Meteb M. Al-Bugami, Salih Bin Salih, Yousef Al Saleh, Salman Abdulaziz
KEYWORDS:
Diabetic Ketoacidosis, Clinical Pathway, Trainees, Quality
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.4 No.4,
October
16,
2014
ABSTRACT: Diabetic Ketoacidosis
(DKA) is a serious and potentially a fatal complication of diabetes mellitus.
Tools to guarantee proper, evidence-based, guideline implementation are of
paramount importance and an essential element for quality patient care.
Clinical pathways represent one such tool that clearly promotes the
implementation of guidelines and research evidence into clinical practice. The
aims of this study were to measure quantitatively and qualitatively the impact
of a specially structured Resident-friendly, DKA clinical pathway on the
application of evidence-based management standards and its acceptability by the
treating resident physicians. A retrospective chart review of patients who were
admitted prior to and after the launching of the clinical pathway and a
questionnaire assessment of resident’s acceptance of the pathway format were
undertaken. Eighty one episodes of DKA in a total of 58 patients fulfilled the
criteria for inclusion in the study. Thirty seven admissions were on the
pathway (45.7%) and 44 were not (54.3%). Documentation of severity indices of
patients who were admitted under the pathway were significantly improved with a
trend for a shorter hospital stay. The duration of intravenous insulin therapy,
intensive care unit consultation and diabetes educator involvement in patient
care were not different between the two groups. Residents found the pathway
user-friendly, educationally very valuable, reduced their workload and had a
positive effect on their DKA management skills.Conclusions: Use of specially
structured, resident-friendly pathway led to significant improvement in documentation
of DKA severity indices and empowered our residents with evidence-based knowledge
and skills to deal with this serious diabetic complication.