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St. Paul's Hospital, Vancouver BC

Physicians at St. Paul's Hospital in Vancouver recognized that hyperkalemia occurs in up to 10 per cent of hospitalized patients, and that although it is a life-threatening condition, there is little consistency in the management of high serum potassium. They conducted a quality improvement project aimed at increasing the proportion of hy­perkalemia cases managed according to the best available evidence and reducing the cost of treatment. A pocket-sized guideline outlining the management of hyperkalemia according to the best available evidence was distributed to in­ternal medicine residents. Cases of hyperkalemia occurring in a two-week period before the guideline was distributed (observational phase) were reviewed retrospectively and compared with cases occurring in two 2-week periods after the guideline was distributed (intervention phase). A review of paper charts and electronic health records indicated that before the intervention, hyperkalemia was managed according to the best available evidence in 63 per cent of cases. After the intervention, cases were managed according to the best available evidence in 94 per cent of cases. In addition, the overall cost incurred per case declined from $16.74 to $7.51.

In summary, providing residents with a user-friendly guideline for hyperkalemia increased the proportion of cases managed according to best available evidence and significantly reduced the cost associated with treatment. (Rajan et al. 2012)