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

作     者：Parampil Thulasidharan Shibu Kandalam Salem Abo Salah Peter Alistair Cameron Jignesh Dhirajlal Trivedi Muhammed Kunhi Kayakool Shahsad Ramachan Parambath Pradeep Radhakrishnan Joe Varghese Mathew Jaseem Sirajudeen 

作者机构：Department of General Internal Medicine Hamad General Hospital Doha Qatar Department of Epidemiology & Preventive Medicine Monash University Melbourne Australia 

出 版 物：《Open Journal of Internal Medicine》 (内科学期刊（英文）)

年 卷 期：2019年第9卷第4期

页      面：112-120页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Diabetes Mellitus Diabetic Ketoacidosis DKA Audit Emergency Department Expedited Discharge Length of Stay 

摘      要：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.