A patient named Lauren has been admitted to the ICU after being admitted and diagnosed in the emergency room with diabetic ketoacidosis. She was a 34-year-old female and had type 1 diabetes. As an on-call nurse in the ICU, I received the patient during admission. During handover, the emergency room nurse indicated that Lauren has been treated frequently in the past 6 months, with the same diagnosis of diabetic ketoacidosis. The ICU doctor had recognized the patient as well. The emergency room staff was concerned that she was not receiving the correct treatment due to the frequency of readmissions. Lauren has had a history of using drugs, which was relevant as indicated by a 2013 study by Isidro and Jorge that found that 20.6% of diabetic ketoacidosis patients are associated with recreational drug use, with a 70% readmission rate. However, upon ordering and running a toxicology report, no trace of drug use was found. Upon running additional tests to rule out differential diagnoses, the ICU team was stumped on how else Lauren could be helped to prevent readmissions in the future.

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As a nurse, I was familiar with other roles, so I suggested consulting a dietician and a social worker with the premise that Lauren may have lacked knowledge and awareness regarding the use of insulin for her Type 1 diabetes. The dietician and social worker were briefed on the case and I shared my concerns with them. The information from the nurse helped to guide the assessment of the patient by these specialists. The dietician confirmed the insulin injection technique and scheduling, finding only small discrepancies which were quick to correct via the teach-back method, and could not have caused the diabetic ketoacidosis. Upon an interview with a social worker, it became evident that food insecurity could have played a role and Lauren could not adequately control her glucose levels with access to and foods with appropriate hypoglycemic indexes. Lauren relied on food stamps and soup kitchens for access to food, but only received aid for 3 out of 4 weeks each month. Using this information, the dietician suggested that Lauren could have caused hypoglycemia by taking the insulin dose without food. The episodes of diabetic ketoacidosis occurred periodically, likely at the time when Lauren ran low on food stamps.

Lauren was treated, and before discharge, received appropriate education from the dietician and nurses regarding insulin adjustment and monitoring her diet to avoid hypoglycemia. The social worker provided her with resources to apply for additional aid and addresses of local food banks. This situation represented various instances of interprofessional collaboration. First, the handover showed collaboration alongside competent handover procedures as the emergency room nurse shared critical information with me regarding the patient status and previous visits, which helped identify that there is a pattern. There was the standard collaboration between the ICU doctor and nurses including me, discussing the test results and potential options. Finally, the hospital social worker was brought on to collect information about the patient’s lifestyle and financial situation while a dietician assessed her diet and insulin management. With the combination of information, the underlying cause of Lauren’s admissions with diabetic ketoacidosis was found and she was provided with the education and tools to manage her health and well-being. The contributions of clinicians and specialists at various levels provided critical input in the diagnosis and treatment of a patient which presented a challenging case to hospital staff.

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The Vila Health scenario demonstrates the importance of interdisciplinary collaboration in a rapidly evolving healthcare environment. Unfortunately, there is little evidence for success in this situation. The primary outcome of establishing an EHR system was achieved, with some collaboration between upper management and the facility administration, and the attempt to reinforce the system used by providing training. However, the approaches to the situation at every level were abysmal which led to really poor integration of Healthix. It was unsuccessful in terms that none of the staff who were responsible for managing and using the system were consulted or prepared that drastically slowed implementation. This was followed by a lack of communication, adequate training, or a unified approach