KW. Yong, MP. Moore and H. Lunt (2014). Medically facilitated discharge of adult diabetic ketoacidosis admissions: precipitants and average length of stay. The New Zealand medical journal, 127(1392), 86-94.

PubMed 24806251

[Abstract]
AIMS: To assess the impact of medically facilitated discharge by a specialist registrar on diabetic ketoacidosis (DKA) length of stay (LOS) and to collect data from these DKA admissions for a descriptive summary of their clinical and biochemical characteristics.

METHOD: DKA admissions were identified through the electronic patient management system, Monday to Friday over a 9 month period. The admitting team was then offered assistance with discharge planning ('study intervention'). The registrar also collected clinical information for all identified DKA admissions.

RESULTS: There were 71 DKA admissions; 92% had type 1 diabetes and 56% were overnight admissions. Following exclusion of four admissions with prolonged LOS secondary to major comorbidities, mean LOS fell from 3.7 (± 1.0) to 2.8 (± 0.3) days. Facilitated discharge had no major impact on LOS. The commonest precipitant for admission was insulin omission, accounting for 65% of admissions. Local practice was to discharge patients following resolution of acidosis, but prior to complete abolition of ketosis.

CONCLUSIONS: The majority of DKA admissions were of short duration. Achieving further reduction in LOS is therefore difficult. Insulin omission was the commonest DKA precipitant. Diabetes clinical resources may be best allocated on preventing DKA admissions, rather than facilitating early discharge.