Health Education West Midlands and honorary research fellow, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Clin Med (Lond). 2017 Oct;17(5):389-394. doi: 10.7861/clinmedicine.17-5-389.
Efficient management of diabetic ketoacidosis (DKA) improves outcomes and reduces length of stay. While clinical audit improves the management of DKA, significant and sustained improvement is often difficult to achieve. We aimed to improve the management of DKA in our trust through the implementation of quality improvement methodology. Five specific targets (primary drivers: fluid prescription, fixed rate intravenous insulin infusion, glucose measurement, ketone measurement and specialist referral) were selected following a baseline audit. Interventions (secondary drivers) were developed to improve these targets and included monthly feedback to departments of emergency medicine, acute medicine, and diabetes. Following our intervention, the mean average duration of DKA reduced from 22.0 hours to 10.2 hours. We demonstrate that regular audit cycles with interventions introduced through the plan-do-study-act model is an effective way to improve the management of DKA.
高效管理糖尿病酮症酸中毒（DKA）可改善预后并缩短住院时间。临床审核可改善 DKA 的管理，但要实现显著且持续的改善往往较为困难。我们旨在通过实施质量改进方法，改善本机构中 DKA 的管理。在基线审核后，选择了五个具体目标（主要驱动因素：液体处方、固定速率静脉胰岛素输注、血糖测量、酮体测量和专科转介）。制定干预措施（次要驱动因素）以改善这些目标，包括每月向急诊医学、急性医学和糖尿病科部门提供反馈。在我们的干预措施后，DKA 的平均持续时间从 22.0 小时缩短至 10.2 小时。我们证明，通过计划-执行-研究-行动模型引入干预措施并定期进行审核，是改善 DKA 管理的有效方法。
