Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when a patient's body produces high levels of blood acids called ketones.
When we started this work, there were approximately 200-300 annual admissions for DKA at the Hospital of the University of Pennsylvania (HUP). An analysis of the emergency department (ED) treatment pathway for DKA showed seven guidelines in use and no consensus around appropriate treatment. Long-held conventions dictated for care to be delivered in the intensive care unit (ICU) despite research showing that level of care to be unnecessary for DKA.
TargetPath is a comprehensive program designed to translate evidence-based guidelines into action at the bedside.
Patients at risk for DKA are identified using a dashboard that monitors admissions into the ED and ED providers are prompted via secure text message with just-in-time evidence-based protocols to take action when patients fulfill care criteria.
The clinician-designed protocol is designed to be actionable and easy to use so that multidisciplinary care teams can provide efficient and high-value care to patients with DKA consistently. At the time of transfer from the ED, huddles with pharmacists ensure the safe transfer of care.
By decreasing care variations and appropriately triaging patients based on the level of care required, TargetPath enables more patients to go directly home from ED, freeing up ICU beds for sicker patients.
During the initial pilot at HUP, TargetPath led to savings of half a day of length of stay for all DKA patients and cut ICU utilization in half. Following the pilot, supporting order sets were built into the electronic health record to guide workflows and further reinforce the pathway.
TargetPath is the standard of care for patients at risk for DKA at HUP. The team's insights and approach to refining and optimizing evidence-based guidelines serve as a roadmap for other clinical teams working to implement standardized care delivery.