OBJECTIVE: To demonstrate the benefit of an institutionally implemented glucose control intervention based on serum and plasma glucose values in the acute inpatient setting. METHODS: In a retrospective analysis, all serum and plasma glucose values from the laboratory information system database from 1999 through 2005 were used to assess implementation of 2 new hospital-wide intravenous and subcutaneous protocols aimed at lowering blood glucose values without increasing the number of hypoglycemic events. In our analysis, we used both a per-patient hyperglycemic index (HGI), an area-under-the-curve analysis, and hospital-wide geometric mean blood glucose to assess glucose control. Bedside capillary blood glucose measurements were not included. RESULTS: More than 630,000 serum and plasma glucose results were available for analysis. The percentage of results above the protocol target of 180 mg/dL decreased from 16.4% before the intervention to 10.0% after the intervention (P<.00001), and we found no change in the proportion of "critical" hypoglycemic results (<50 mg/dL). The hospital-wide geometric mean decreased significantly and coincided with a significant decrease in the fraction of patients with poor glucose control (based on the HGI) from 27.6% to 18.7% (P<.00001). The geometric mean blood glucose was found to be an excellent marker for the HGI (r2 = 0.99). CONCLUSION: We are the first to report improvements in glucose control over an extended period with use of both hospital-wide intravenous and subcutaneous insulin protocols in an academic hospital setting. Furthermore, hospital-wide mean blood glucose levels are excellent surrogates for the more comprehensive calculation of per-patient HGI.
OBJECTIVE: To demonstrate the benefit of an institutionally implemented glucose control intervention based on serum and plasma glucose values in the acute inpatient setting. METHODS: In a retrospective analysis, all serum and plasma glucose values from the laboratory information system database from 1999 through 2005 were used to assess implementation of 2 new hospital-wide intravenous and subcutaneous protocols aimed at lowering blood glucose values without increasing the number of hypoglycemic events. In our analysis, we used both a per-patient hyperglycemic index (HGI), an area-under-the-curve analysis, and hospital-wide geometric mean blood glucose to assess glucose control. Bedside capillary blood glucose measurements were not included. RESULTS: More than 630,000 serum and plasma glucose results were available for analysis. The percentage of results above the protocol target of 180 mg/dL decreased from 16.4% before the intervention to 10.0% after the intervention (P<.00001), and we found no change in the proportion of "critical" hypoglycemic results (<50 mg/dL). The hospital-wide geometric mean decreased significantly and coincided with a significant decrease in the fraction of patients with poor glucose control (based on the HGI) from 27.6% to 18.7% (P<.00001). The geometric mean blood glucose was found to be an excellent marker for the HGI (r2 = 0.99). CONCLUSION: We are the first to report improvements in glucose control over an extended period with use of both hospital-wide intravenous and subcutaneous insulin protocols in an academic hospital setting. Furthermore, hospital-wide mean blood glucose levels are excellent surrogates for the more comprehensive calculation of per-patient HGI.
Authors: Nestoras Mathioudakis; Peter J Pronovost; Sara E Cosgrove; Daniel Hager; Sherita Hill Golden Journal: Jt Comm J Qual Patient Saf Date: 2015-07
Authors: Elizabeth A Martinez; Raul Chavez-Valdez; Natalie F Holt; Kelly L Grogan; Katherine W Khalifeh; Tammy Slater; Laura E Winner; Jennifer Moyer; Christoph U Lehmann Journal: Anesthesiol Res Pract Date: 2011-09-06