A Learner-Centered Diabetes Management Curriculum: Reducing resident errors on an inpatient diabetes pathway

• Published in: Diabetes care Vol. 35; no. 11; pp. 2188 - 2193
• Main Authors: DESALVO, Daniel J, GREENBERG, Larrie W, HENDERSON, Celia L, COGEN, Fran R
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-11-2012
• Subjects: Biological and medical sciences; Children's hospitals; Curricula; Curriculum; Diabetes; Diabetes Mellitus; Diabetes. Impaired glucose tolerance; Education; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Health care; Hospitals; Humans; Inpatients; Insulin; Internship and Residency; Medical errors; Medical Errors - prevention & control; Medical sciences; Metabolic diseases; Miscellaneous; Original Research; Pediatrics; Pediatrics - education; Public health. Hygiene; Public health. Hygiene-occupational medicine; Endocrinopathy; Human; Center; Nutrition; Diabetes mellitus; Error; Metabolic diseases; Hospitalization; Teaching; Educational program; Treatment; Resident (student); Resident; Hospital; Endocrinology
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc12-0450

Diabetes errors, particularly insulin administration errors, can lead to complications and death in the pediatric inpatient setting. Despite a lecture-format curriculum on diabetes management at our children's hospital, resident diabetes-related errors persisted. We hypothesized that a multifaceted, learner-centered diabetes curriculum would help reduce pathway errors.
The 8-week curricular intervention consisted of 1) an online tutorial addressing residents' baseline diabetes management knowledge, 2) an interactive diabetes pathway discussion, 3) a learner-initiated diabetes question and answer session, and 4) a case presentation featuring embedded pathway errors for residents to recognize, resolve, and prevent. Errors in the 9 months before the intervention, as identified through an incident reporting system, were compared with those in the 10 months afterward, with errors classified as relating to insulin, communication, intravenous fluids, nutrition, and discharge delay.
Before the curricular intervention, resident errors occurred in 28 patients (19.4% of 144 diabetes admissions) over 9 months. After the intervention, resident errors occurred in 11 patients (6.6% of 166 diabetes admissions) over 10 months, representing a statistically significant (P = 0.0007) decrease in patients with errors from before intervention to after intervention. Throughout the study, the errors were distributed into the categories as follows: insulin, 43.8%; communication, 39.6%; intravenous fluids, 14.6%; nutrition, 0%; and discharge delay, 2.1%.
An interactive learner-centered diabetes curriculum for pediatric residents can be effective in reducing inpatient diabetes errors in a tertiary children's hospital. This educational model promoting proactive learning has implications for decreasing errors across other medical disciplines.