Whether implementing a structured Friday transition plan improves discharge efficiency and reduces weekend-related delays for Diabetic ketoacidosis (DKA) patients at a District General Hospital in Essex

Author : Fahas Ali Vattiyam Veettil

Abstract :This QIP evaluates whether implementing a structured Friday transition plan improves discharge efficiency and reduces weekend related delays for Diabetic ketoacidosis (DKA) patients at a District General Hospital in Essex. DKA management requires timely transition from fixed rate insulin infusions (FRI) to variable rate insulin (VRI), followed by stepdown to subcutaneous insulin. Delays in this process—especially over weekends—can prolong admissions and increase staff workload, as patients require frequent venous blood gases and medical reviews. Prompt and structured transitions can reduce both staff burden and patient risk. Prolonged stays also increase costs, as an NHS hospital bed costs approximately £345 per day. Princess Alexandra Hospital (PAH), a district general hospital in Essex, admits around 100 DKA patients per month. Improving insulin transitions and discharge efficiency could therefore enhance patient flow and generate significant cost savings. Methods: A retrospective review of 16 DKA inpatients (March–April 2025) was conducted. Data included insulin transition timelines, presence of a documented stepdown plan, weekend handover practices, length of stay (LoS), and discharge delays. Statistical analyses compared LoS between weekday and weekend discharges, and between patients with and without a documented stepdown plan. Cost-effectiveness was also determined. Results: Patients discharged over the weekend had a mean LoS of 8.4 days, compared with 14.9 days for weekday discharges, though this difference was not statistically significant (t = –1.24, p = 0.24). Patients with a documented stepdown plan (n = 3) had a mean LoS of 4.7 days, compared with 13.4 days for those without, a difference of 8.7 days saved per admission (t = –1.74, p = 0.18). Although underpowered, this finding is clinically important. With each inpatient bed costing £345 per day, this equates to approximately £3,000 saved per admission, or £300,000 monthly and £3.6 million annually if applied to all DKA admissions. Conclusion: This QIP demonstrates a strong trend toward shorter hospital stays in DKA patients with structured stepdown planning. Implementing a standardized Friday stepdown protocol, improving weekend handovers, and ensuring DSN support could enhance discharge efficiency, reduce unnecessary bed occupancy, and yield substantial annual savings—potentially over £3.6 million at PAH.

Keywords :Health economic analysis, innovation, education.

Conference Name :International Conference on Clinical Medicine and Patient Care (ICCMPC-25)

Conference Place Vancouver, Canada

Conference Date 1st Nov 2025