SL. Waller, S. Delaney and MW. Strachan (2007). Does an integrated care pathway enhance the management of diabetic ketoacidosis?. Diabetic medicine : a journal of the British Diabetic Association, 24(4), 359-63. https://doi.org/10.1111/j.1464-5491.2007.02102.x

PubMed 17298587

[Abstract]
AIMS: Integrated Care Pathways (ICPs) are management plans that indicate the sequence and timing of the optimal treatment for individuals with a given disorder. The treatment of diabetic ketoacidosis (DKA) before and after the implementation of an ICP in a teaching hospital was examined.

METHODS: Twenty-seven episodes of DKA were identified during the 13-month control period and 22 in the 13 months following implementation of the ICP. Case notes were reviewed and relevant clinical data extracted.

RESULTS: The introduction of the ICP was associated with a reduction in the time taken to initiate intravenous fluid [45.0 (5-225) min to 37.5 (0-135) min; P = 0.01]. Time taken to initiate insulin infusion was also reduced [60.0 (5-755) min to 37.5 (0-175) min; P = 0.02]. The proportion of patients commenced on intravenous insulin within 60 min increased from 48 to 77% (P = 0.04). In addition, there was a reduction in the prescription of antibiotics (48-18%; P = 0.028) and low molecular weight heparin (59-5%; P < 0.001). Length of stay was not affected.

CONCLUSION: The ICP significantly improved key areas in the management of DKA, although there remains room for further improvements.