Disparities in Adherence to Pediatric Diabetic Ketoacidosis Management Guidelines Across a Spectrum of Emergency Departments in the State of Indiana: An Observational In Situ Simulation-Based Study
| Autor: | Brian C Phillips, Riad Lutfi, Erin E White, Kamal Abulebda, Michele L Kirby, Courtney T Frye, Lee D Murphy, Samer Abu-Sultaneh |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
030504 nursing Diabetic ketoacidosis business.industry MEDLINE 030209 endocrinology & metabolism General Medicine Emergency department medicine.disease Logistic regression Checklist 03 medical and health sciences Patient safety 0302 clinical medicine Interquartile range Pediatrics Perinatology and Child Health Emergency medicine Emergency Medicine medicine Observational study 0305 other medical science business |
| Zdroj: | Pediatric emergency care. |
| ISSN: | 1535-1815 |
| Popis: | Background Diabetic ketoacidosis (DKA) is a common presentation to an emergency department (ED), with the majority presenting to community EDs. Adherence to clinical guidelines in these EDs can reduce morbidity and mortality. Few methods to describe practice gaps for DKA management have been reported. Objectives We hypothesized that high-fidelity in situ simulation can be used to measure and compare the quality of the care provided to pediatric patients with DKA presenting to community EDs in the state of Indiana. Methods This observational study examined multiprofessional teams caring for a simulated pediatric patient who presented with DKA to community EDs. The primary outcome was overall adherence to pediatric DKA guidelines as measured by a validated performance checklist. A composite adherence score (CAS) was calculated using the sum of 9 checklist performance parameters. Multivariable logistic regression was used to examine the impact of ED volume and characteristics on the scores. Results A 49 multiprofessional teams from 13 sites were enrolled. Of the 252 participants, 26 (10.3%) were physicians, 143 (56.7%) registered nurses, 25 (9.9%) respiratory therapists, and 58 (23.0%) were other. The overall CAS for all sites was 55.6% (25th, 75th interquartile range, 44.4%, 66.7%). Excessive intravenous fluid boluses were given by 53.1%, whereas 30.6% and 26.5% incorrectly administered insulin and sodium bicarbonate boluses, respectively. Only 10.2% used an appropriate intravenous fluid rate, and 57.1% performed an hourly glucose. No significant difference in the CAS was found due to pediatric ED volume or presence of an inpatient pediatric service. Conclusions Using validated in situ simulation; we revealed high variability in adherence to the pediatric DKA management guidelines at a wide range of community EDs. A statewide education initiative focused on decreasing variation and improving adherence to pediatric DKA guidelines is necessary for patient safety. |
| Databáze: | OpenAIRE |
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