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  • Title: Does an integrated care pathway enhance the management of diabetic ketoacidosis?
    Author: Waller SL, Delaney S, Strachan MW.
    Journal: Diabet Med; 2007 Apr; 24(4):359-63. PubMed ID: 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.
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