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Impact of the Electronic Health Record (EHR)-Based ‘Critical Care DKA Protocol’ on the Management of Diabetic Ketoacidosis: A Single Center Experience at a Community Teaching Hospital FREE TO VIEW

Reshma Ramakrishnan, MD; Abhishek Kulkarni, MD
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Robert Packer Hospital, Sayre, PA

Chest. 2013;144(4_MeetingAbstracts):524A. doi:10.1378/chest.1703469
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SESSION TITLE: Clinical Improvement Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Diabetic Ketoacidosis (DKA) is a critical complication of type 1 diabetes mellitus. The American Diabetes Association (ADA) introduced an algorithmic protocol for the management of adult patients with DKA (Diabetes Care, Vol. 32, Issue 7, 2009). Based on this, the ‘Critical Care DKA Protocol’ was designed and introduced as a complete Electronic Health Record (EHR)-based order set at Robert Packer Hospital and came into effect from October 2009. The objective of this study was to analyze the impact of this standardized order set on the management of patients with DKA admitted to the medical ICU.

METHODS: After obtaining IRB approval, data from 165 patients (Oct 2005 to Nov 2012) admitted to the ICU with the principal diagnosis of DKA was analyzed. Patients were divided into 2 groups: group 1: before (n = 80) and group 2: after (n = 85) the date of introduction of the order set (October 2009). Following outcomes were compared between the two groups using unpaired t test: 1. Time needed to achieve closure of anion gap, 2. Time needed to attain a blood glucose level of 200 mg/dl, 3. Length of ICU stay solely for the purpose of management of DKA, 4. Number of hypoglycemic episodes.

RESULTS: The time to achieve closure of anion gap (p = 0.036) and number of hypoglycemic episodes (p = 0.014) were noted to be significantly lower in group 2. The time to attain blood glucose level of 200 mg/dl and length of ICU stay were also lower in group 2 as compared to group 1, however p values for these did not reach statistical significance.

CONCLUSIONS: The EHR-based ‘Critical Care DKA Protocol’ was more effective than the conventional method of insulin titration in the management of patients with DKA.

CLINICAL IMPLICATIONS: For institutions with an EHR system in place, that still follow the conventional method of insulin titration, adopting an EHR-based standardized order set has the potential to improve patient outcomes and reduce complications in the management of DKA.

DISCLOSURE: The following authors have nothing to disclose: Reshma Ramakrishnan, Abhishek Kulkarni

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