1038-P: Evaluation of an Outpatient Pathway for Management of Pediatric Patients with New-Onset Diabetes

Abstract

Background: Education and management for new onset diabetes (NOD) does not always require hospitalization. A pathway for outpatient management of pediatric NOD patients after initial evaluation and long-acting insulin dose in the emergency department was developed at a tertiary academic medical center. Methods: A multidisciplinary team identified key initial eligibility criteria for outpatient NOD management including absence of DKA, age ≥3 years, and beta-hydroxybutyrate (BOHB) <1 mmol/L. Data tracking, chart review, and endocrine provider surveys determined reasons for exclusion or non-participation. Control charts tracked and analyzed monthly utilization. Refinement of the pathway occurred through iterative PDSA cycles. Results: The pathway launched in September 2020. To date, 58 eligible children (33%) have completed the pathway (monthly median 33%). One patient was hospitalized after newly identified social concerns. Increase of BOHB cut-off to 1.5 mmol/L and option of rapid-acting insulin bolus for borderline BOHB resulted in significant shift in utilization from mean 23% to 41%. Barriers to participation include limited space availability, weekend presentation, and patient/family refusal. Conclusion: Data suggest that outpatient management is feasible for select patients with NOD but requires flexible resources and supportive patient messaging regarding outpatient education. Disclosure S.Azova: None. E.Rhodes: None. C.Baskaran: None. S.Einis: None. J.A.Fortin: None. M.Silva: None. K.Aamodt: None. B.G.Ethier: None. S.Nanavati: None. K.Garvey: None.