Expedited Discharge of Patients with Diabetic Ketoacidosis in an Emergency Department Short Stay Unit

Abstract

Aim: Review of presentation, management and outcome of patients admitted with Diabetic Ketoacidosis (DKA) to an emergency department short stay unit with expedited discharge. Methods: All admitted patients with a discharge diagnosis of “Diabetic Ketoacidosis”, were identified by the file auditing section in the Emergency Department. Data obtained from the medical records were collected using an explicit chart review from January 2012 to June 2013. Data included clinical monitoring, investigations performed, the type and amount of intravenous fluids given, the insulin regime, potassium supplementation and outcome. Results: Out of a total of 120 patients labelled as DKA or hyperglycaemia on arrival, hundred patients fulfilled the criteria for DKA. In the population studied the mean age was 25 years with a male predominance. Eighty-two patients suffered from Type 1 Diabetes Mellitus (T1DM) whilst eighteen patients had Type 2 Diabetes Mellitus (T2DM). Sixteen patients were newly diagnosed during the present admission. Seventy-six (76%) patients were on insulin. The insulin regimen and potassium supplementation were followed as per protocol in all patients. All the patients except one were given intravenous fluid according to protocol. Parameters were monitored adequately except fluid input and output monitoring. The median length of stay in the short stay unit was 1.5833 days. There was no return visit within one week of discharge. Conclusion: The median length of stay was short and there were no documented complications or deaths during the stay. There was poor compliance with documentation of fluid input and output. In this population, the short stay model of care appeared to be safe and efficient.