Improving the Inpatient Management of Central Diabetes Insipidus Post- Transsphenoidal Pituitary Surgery

Central diabetes insipidus is a common complication of transsphenoidal pituitary surgery. Damage to the pituitary stalk during surgery results in the disruption of water homeostasis, resulting in increased thirst and the production of large volumes of dilute urine. While symptomatic central diabetes insipidus can be managed with the administration of desmopressin, it has the potential to progress to severe dehydration, hypernatremia and become a life-threatening medical emergency. This project utilised the DMAIC framework and associated quality improvement tools to structure a quality improvement plan aimed to reduce the length of stay for patients diagnosed with central diabetes insipidus post-transsphenoidal pituitary surgery by investigating the current management pathway. The results of this project revealed that (1) the median length of stay for a patient diagnosed with post-operative central diabetes insipidus increased from 15 days to 17 days and (2) there is an increased incidence of both hypernatremia and hyponatremia amongst these patients. Specific laboratory results and clinical observations are used to determine a patients eligibility to receive treatment for diabetes insipidus. The lack of an available standardised reference guide in this institution may have resulted in the inconsistencies in available results found in this project. Based upon a review of literature pertinent to this topic and the analysis of results this quality improvement project plan proposes the implementation of standardised guidelines for the inpatient management of central diabetes insipidus post-transsphenoidal pituitary surgery to maintain and promote safe and effective patient care in the future.