Assessment of the Quality of Care of Patients with Diabetic Emergencies Admitted in the Philippine General Hospital
Objective. This is a health systems research conducted with the goal of evaluating the quality of care (QoC) in diabetic emergencies, specifically Diabetic Ketoacidosis (DKA) and Hyperglycemic hyperosmolar state (HHS), at the Philippine General Hospital (PGH) in terms of structures, processes and outcomes, and determining facilitators and barriers to effective delivery of care from the healthcare providers’ point of view.
Methods. The first phase of this study is a retrospective chart review involving an audit of the quality of services rendered to patients diagnosed to have DKA/HHS at the PGH. The second phase is a series of focus group discussions (FGDs) among physicians and nurses involved in the care of DKA/HHS patients. Facilitators and barriers to delivery of care were identified in these FGDs, as well as recommendations on how to improve delivery of care.
Results. The recognition of DKA/HHS as a possible diagnosis at first encounter was observed in only 67% of cases. Timely initiation of hydration was met in 40% of cases and only 10% of the patients underwent adequate laboratory monitoring. Correction of at least half of the estimated water deficit in the first 24 hours of admission was achieved in 84% of the cases. Despite this, mortality rate was still high at 23%. Among those who died, thirty-seven percent (37%), seventy-five percent (75%) and over thirty percent (31%) had delayed initiation of hydration, at least one episode of hypokalemia or hypoglycemia, respectively. Barriers to good quality of care for DKA/HHS were mostly attributed to delays. These delays were due to lack of resources, limited bed-capacity and challenges experienced in the handling of specimen from the ER clerk to the laboratory and release of results.
Conclusion. Failure to follow guidelines and delays in the delivery of care are possible reasons for the high mortality rates noted and could be a reflection of poor quality of care among DM emergency patients in PGH. Proper documentation in the medical charts is also important. Clinical pathways and DM emergency kits are a few of the suggested approach to address the barriers to good quality care.