Carolinas Research Day 2021

Clinical Studies

01 Evaluation of the Emergency Department Management of Children With Diabetic Ketoacidosis

Alyssa DaVolio, OMSIV, Jacob Andrews, OMSIV, Christine Angeles, OMSIV, Brittany Skaggs, OMSIV, Mackenzie Dreher, OMSIV, Ning Cheng, PhD, Hanna S. Sahhar, MD, FAAP, FACOP

Edward Via College of Osteopathic Medicine-Carolinas, Spartanburg Regional Healthcare System

Abstract: The hypothesis of this study is that the management of diabetic ketoacidosis along with time flow of admission from the emergency department will improve after the implementation of electronic medical records. After initial workup and stabilization patients are often transferred to the pediatric intensive care unit for further treatment. The purpose of this study is to re-evaluate the management of diabetic ketoacidosis and time flow in the emergency department before and after the implementation of electronic medical records. A retrospective chart review of 247 subjects between the ages of 0-18 years admitted to the pediatric intensive care unit with a diagnosis of diabetic ketoacidosis and bicarbonate level <15 was conducted. Data collected included the subjects’ gender, age, race, weight, height, initial vitals at emergency department admission, emergency department diagnosis, time from admission to emergency department to decision to admit to the pediatric intensive care unit, time from decision to admit to the pediatric intensive

care unit to transfer to the pediatric intensive care unit, fluids (0.9% NaCl) given in the emergency department, amount of insulin given in the emergency department, the route of administration (IV drip vs bolus), blood gas results collected, and blood glucose results collected. The average throughput times prior to the use of electronic medical records in the emergency department were as follows: time from admission to the emergency department to decision to admit to the pediatric intensive care unit was 2.02 hours ± 1.65. The time from the decision to admit to the pediatric intensive care unit to transfer to the pediatric intensive care unit was 1.15 hours ± 1.10. These results were compared to throughput after implementation of electronic medical records in the emergency department which were as follows: time from admission to the emergency department to decision to admit to the pediatric intensive care unit was 0.66 hours ± 1.30. The time from the decision to admit to the pediatric intensive care unit to transfer to the pediatric intensive care unit was

2.10 hours ± 1.39. Comparing the averages between the two groups, we found there was a statistically significant decrease in time from admission to the emergency department to decision to admit to the pediatric intensive care unit of 1.36 hours (82 minutes) (p<0.001) after the implementation of electronic medical records. Additionally, there was a statistically significant increase in time from the decision to admit to the pediatric intensive care unit to transfer to the pediatric intensive care unit of 0.45 hours (27 minutes) (p<0.001) after the implementation of electronic medical records. More specifically, the implementation of electronic medical records allowed for quicker time from admission to the emergency department to decision to admit to the pediatric intensive care unit. However, the time from the decision to admit to the pediatric intensive care unit to transfer to the pediatric intensive care unit increased after the implementation of electronic medical records.

18