Background/Aims: Hospitalisation rates for DKA are higher in socioeconomically disadvantaged areas1. A previous Queensland tertiary hospital study noted superior clinical outcomes in acute DKA management when the Queensland standardised statewide protocol was utilised2. Our centre resides in a low socioeconomic catchment and we were interested to examine awareness and adherence to this protocol.
Method: Thirty medical officers (MOs) were surveyed to ascertain awareness of the protocol, and barriers to its use. A retrospective audit of patients admitted with DKA from 1 April 2016 to 31 July 2016 was also performed (n=56). Adherence to the protocol was assessed for patients meeting the protocol’s definition of DKA. This involved assessing adherence to each management component outlined under the four key areas of the protocol (Immediate Management ‘Hour 1’, Ongoing Management ‘Hours 2-4’, Subsequent Management ‘Hour 4 onwards’ and Discharge Planning). Clinical outcomes were compared between patients managed with the protocol, and those who were not.
Results: The majority of MOs had awareness of the protocol (83%), however only 67% were able to physically/electronically locate it. Adherence rates to key areas of the protocol were generally poor. Components of discharge planning were adhered to best (66% adherence), followed by immediate management (62%), ongoing management (55%) and subsequent management (44%). Rates of hypokalaemia and hypoglycaemia were lower in patients managed with the protocol versus those who were not (55% vs 66% and 0% vs 33% respectively). Time to transition to subcutaneous insulin and length of stay were also reduced in the protocol group (22.6 vs 41.1 hours and 2.58 vs 4.58 days respectively).
Conclusion: There was reasonable awareness of the Queensland standardised statewide protocol at our centre, but difficulty locating it. There was low adherence to the protocol, associated with poorer clinical outcomes. We plan to implement strategies to improve performance and re-audit.