SHM Converge Scientific Abstract ePoster Gallery-Experiences and Challenges in Managing Mild to Moderate Diabetic Ketoacidosis Patients With Subcutaneous Insulin on the Medical Floor

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This document describes a hospital project to manage <strong>mild to moderate diabetic ketoacidosis (DKA)</strong> on a <strong>medical floor</strong> using <strong>protocolized subcutaneous insulin</strong>, rather than the traditional ICU insulin infusion approach.

The team developed an order set with input from emergency medicine, critical care, endocrinology, hospital medicine, pharmacy, and nursing. The protocol was designed to improve <strong>patient safety, quality of care, and resource use</strong>, especially during periods of hospital bed shortage. Patients with mild to moderate DKA were triaged in the emergency department to either the ICU or the medical floor based on severity and exclusion criteria.

<strong>DKA criteria</strong> included:
- Blood glucose ≥ 250 mg/dL
- β-hydroxybutyrate ≥ 3.0 mmol/L
- Acidosis with pH ≤ 7.30 or bicarbonate < 18 mEq/L

<strong>Exclusion criteria</strong> included severe acidosis, very low bicarbonate, advanced kidney disease, shock, coma, acute myocardial ischemia or heart failure, anasarca, and pregnancy.

Patients appropriate for the floor received fluids and subcutaneous insulin in the emergency department and were then admitted to a <strong>dedicated medical floor</strong>, where glucose was checked every 2 hours and metabolic panels every 4 hours. Once the anion gap closed, patients resumed diet and transitioned to home insulin.

The project found that floor-based management was <strong>feasible and safe in selected patients</strong>. Outcomes such as lab monitoring completion, hypoglycemia, time to acidosis resolution, and length of stay were comparable to ICU care, though some differences were not statistically significant. The authors noted that floor patients generally had <strong>less severe illness</strong>, which may explain some favorable trends.

A major challenge was <strong>staff confusion and hesitancy</strong> during early implementation, especially among prescribers, nurses, and pharmacists. The authors conclude that successful implementation requires <strong>leadership support, ongoing education, and continuous monitoring</strong>.

Asset Subtitle

Bipin Thapa

Meta Tag

Author List Asif Surani, Bipin Thapa, Hari Paudel, Jeanette Carreras, Molly Robischon

Category Innovations

Concept Diabetic Ketoacidosis

Concept Medical Floor

Concept ICU

Concept Subcutaneous Insulin

Concept Intravenous Fluid Therapy

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Bipin Thapa

Track Value in Hospital Medicine

Keywords

diabetic ketoacidosis

DKA

subcutaneous insulin

medical floor

ICU

protocolized care

hospital protocol

patient safety

endocrinology

resource utilization

Diabetic Ketoacidosis

Medical Floor

ICU

Subcutaneous Insulin

Intravenous Fluid Therapy