PC1246: Creation of a Diabetes and Diabetic Ketoacidosis Clinical Care Guideline

Purpose/Objectives: The evidence-based management of children with diabetes and diabetic ketoacidosis (DKA) is limited by unwarranted variation, system barriers, and workflow inefficiencies. This leads to delays in identification and suboptimal treatment which may result in undesired outcomes.

The goal of this project was to develop, implement, and sustain a Clinical Care Guideline (CCG) for the management of patients with known and new-onset diabetes mellitus, from the time of their arrival at Lurie Children’s Hospital to the time of discharge home.

Design/Methods: A multidisciplinary group of stakeholders and relevant representatives met weekly for 15 months. Initial meetings focused on current state analysis and barrier assessments; subsequent meetings focused on development of the CCG, creation of metrics, and plans for implementation of various interventions.

Results: We created a comprehensive Diabetes and DKA CCG including patient care algorithms, order sets, note templates, and educational materials, which was activated in October 2020. In the 12 months following implementation of the Diabetes & DKA CCG, we aimed to measure and track our efficiency in the recognition and treatment of diabetic patients. Specifically, we aimed to decrease time from patient arrival to administration of saline bolus and insulin, increase order set use, maintain observed/expected hospital length of stay (LOS) < 1.0, and maintain a stably low hospital readmission rate. We were successful in measuring and tracking all of these metrics. PDSA cycles included introduction of the CCG and educational efforts to promote awareness of the CCG, re-organization of order set components, and re-structuring of algorithm elements based on iterative feedback.

Conclusion/Discussion: Our multidisciplinary team was successful in developing and implementing a complicated CCG for the management of patients with diabetes and DKA. Frequent communication with front line providers is key in publicizing new processes and soliciting feedback for suggested changes. In the coming months we will continue to monitor post-implementation data, pursue continued educational efforts to promote the use of these tools, and refine components of the CCG to drive further improvements.