Regular and frequent feedback of specific clinical criteria delivers a sustained improvement in the management of diabetic ketoacidosis 

Research output: Contribution to journalArticlepeer-review


  • Ben Coombs
  • J.S. Joht Singh Chandan
  • Jaffar Al-Sheikhli
  • Bhavana Shyamanur
  • Kasun Theivendran
  • Anitha Vijayan A.V. Melapatte
  • Umesh Salanke
  • Mohammed Akber
  • Sandip Ghosh


Efficient management of diabetic ketoacidosis (DKA) improves outcomes and reduces length of stay. While clinical audit improves the management of DKA, significant and sustained improvement is often difficult to achieve. We aimed to improve the management of DKA in our trust through the implementation of quality improvement methodology. Five specific targets (primary drivers: fluid prescription, fixed rate intravenous insulin infusion, glucose measurement, ketone measurement and specialist referral) were selected following a baseline audit. Interventions (secondary drivers) were developed to improve these targets and included monthly feedback to departments of emergency medicine, acute medicine, and diabetes. Following our intervention, the mean average duration of DKA reduced from 22.0 hours to 10.2 hours. We demonstrate that regular audit cycles with interventions introduced through the plan-do-study-act model is an effective way to improve the management of DKA.


Original languageEnglish
Pages (from-to)389-394
Number of pages6
JournalClinical Medicine
Issue number5
Publication statusPublished - 1 Oct 2017


  • Causes, Diabetic ketoacidosis, Duration till resolution, Length of stay, Quality improvement, diabetic ketoacidosis, duration till resolution, length of stay, quality improvement

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