[Training and testing for capillary blood glucose and ketone levels on triage: impact on the early management of diabetic ketoacidosis in an emergency department].

Objectives: To study the impact of an intervention that included a training component and testing for glucose and ketone levels at the time of triage. The effect was evaluated on the basis of times to early management of diabetic ketoacidosis (DKA) in an emergency department.

Material And Methods: Quasi-experimental study with preintervention (January 2010 to November 2013) and postintervention (January 2014 to June 2015) periods in patients over the age of 15 years with DKA in a secondarycare hospital emergency department. The intervention consisted of training sessions for emergency physicians and nurses, the measurement of glucose on triage, and testing for ketonemia with beta-hydroxybutyrate strips on detection of a high glucose level. The outcome variables were the percentages of patients receiving intravenous insuline and isotonic saline within an hour of triage.

Results: We included 61 patients (preintervention, 41; postintervention, 20). The mean (SD) age was 40 (22) years and 36 (59%) were males. Adherence to clinical practice guidelines improved in the postintervention period. The rate of intravenous administration of insulin increased from 29.3% in the preintervention period to (75.0% postintervention (P=.001); isotonic saline administration increased from 51.2% to 80.0% (P=.031).

Conclusion: A strategy that includes training and glucose and ketone testing on triage could facilitate earlier management of DKA in emergency departments.