Evaluation of electronic order set implementation in patients with diabetic ketoacidosis: a retrospective cohort study.

BACKGROUND

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes requiring timely insulin administration and dynamic fluid/electrolyte management.

OBJECTIVES

The aim of this study is to assess the effectiveness of an electronic order set (PowerPlan) on time to DKA resolution compared to individual order prescribing.

DESIGN

Retrospective cohort study.

METHODS

This study included patients (⩾14 years old) with DKA, identified via electronic medical records, and matched to pre- and post-PowerPlan groups. The primary outcome was time to DKA resolution. Secondary outcomes included hospital length of stay, appropriateness of initial intravenous fluids, and insulin infusion. Safety outcomes included the number of hypoglycemia, hyperkalemia, and hypokalemia events until DKA resolution.

RESULTS

Of 226 matched patients (113 per group), baseline characteristics were comparable. The post-implementation group achieved faster DKA resolution (median 10.6 vs 12.6 h; p = 0.002), higher adherence to fluid and insulin protocols, and shorter hospital stay (3.15 vs 3.61 days; p = 0.04). Safety outcomes were similar, with fewer hypoglycemic events and comparable electrolyte abnormalities.

CONCLUSION

Implementation of the DKA PowerPlan significantly shortened time to resolution and reduced hospital stay without compromising safety. These findings support standardized electronic order sets to enhance efficiency and quality of DKA management.