Development of an integrated Diabetic Ketoacidosis fast track system

Abstract

Background: Diabetic Ketoacidosis (DKA) is an acute, life‑threatening condition that can cause serious harm or death without timely, appropriate management. Consequently, the Thammasat Diabetes Center of Excellence developed the "DKA fast track " system. This initiative aims to ensure that DKA patients receive rapid and accurate treatment in accordance with established standards, to reduce treatment duration and mortality.

Objective: Attain "out of DKA" status within 18 hours in over 80% of diabetic ketoacidosis patients.

Materials and Methods: The DKA fast track system was designed to streamline care for DKA patients through staff training, clear protocols, and multidisciplinary teamwork. Developed features include enhanced screening and diagnostics, expedited lab reporting, efficient patient transfers, and systematic monitoring with continuous care guidelines.

Result: Faster screening, diagnosis, and treatment improved DKA outcomes. For mild to moderate DKA, 91.67% of patients recovered within 18 hours (time reduced from 15.43 to 9.18 hours). For severe DKA, 63.21% achieved recovery in 18 hours (from 18.08 to 15.56 hours). Labs reported 86.8% of results within 30 minutes. All DKA patients were transferred to wards within 30 minutes. The 28-day readmission rate was 1.92%, and mortality was 0%.

Conclusion: The success rate for achieving "out of DKA" status within 18 hours met the established goals in mild to moderate DKA. The development of the DKA fast track system enables rapid diagnosis and provides comprehensive care for DKA patients across all dimensions.