Robert J Rushakoff1, Joshua A Rushakoff2, Zachary Kornberg2, Heidemarie Windham MacMaster3, Arti D Shah4,5. 1. Division of Endocrinology and Metabolism, University of California, San Francisco, 2200 Post St., Suite C-430, San Francisco, CA, 94115, USA. robert.rushakoff@ucsf.edu. 2. School of Medicine, University of California, San Francisco, San Francisco, CA, USA. 3. Departments of Pharmacy and Nursing, University of California, San Francisco, San Francisco, CA, USA. 4. Division of Endocrinology and Metabolism, University of California, San Francisco, San Francisco, CA, USA. 5. Division of Endocrinology and Metabolism, University of California, Los Angeles, Los Angeles, CA, USA.
Abstract
PURPOSE OF REVIEW: Inpatient hyperglycemia is common and is linked to increased morbidity and mortality. We review current and innovative ways diabetes specialists consult in the management of inpatient diabetes. RECENT FINDINGS: With electronic medical records (EMRs), remote monitoring and intervention may improve the management of inpatient hyperglycemia. Automated reports allow monitoring of glucose levels and allow diabetes teams to intervene through formal or remote consultation. Following a 2-year transition of our complex paper-based insulin order sets to be EMR based, we leveraged this change by developing new daily glycemic reports and a virtual glucose management service (vGMS). Based on a daily report identifying patients with two or more glucoses over 225 mg/dl and/or a glucose <70 mg/dl in the past 24 h, a vGMS note with management recommendations was placed in the chart. Following the introduction of the vGMS, the proportion of hyperglycemic patients decreased 39% from a baseline of 6.5 per 100 patient-days to 4.0 per 100 patient-days The hypoglycemia proportion decreased by 36%. Ninety-nine percent of surveyed medical and surgical residents said the vGMS was both important and helpful.
PURPOSE OF REVIEW: Inpatient hyperglycemia is common and is linked to increased morbidity and mortality. We review current and innovative ways diabetes specialists consult in the management of inpatient diabetes. RECENT FINDINGS: With electronic medical records (EMRs), remote monitoring and intervention may improve the management of inpatient hyperglycemia. Automated reports allow monitoring of glucose levels and allow diabetes teams to intervene through formal or remote consultation. Following a 2-year transition of our complex paper-based insulin order sets to be EMR based, we leveraged this change by developing new daily glycemic reports and a virtual glucose management service (vGMS). Based on a daily report identifying patients with two or more glucoses over 225 mg/dl and/or a glucose <70 mg/dl in the past 24 h, a vGMS note with management recommendations was placed in the chart. Following the introduction of the vGMS, the proportion of hyperglycemicpatients decreased 39% from a baseline of 6.5 per 100 patient-days to 4.0 per 100 patient-days The hypoglycemia proportion decreased by 36%. Ninety-nine percent of surveyed medical and surgical residents said the vGMS was both important and helpful.
Authors: Robert J Rushakoff; Mary M Sullivan; Jane Jeffrie Seley; Archana Sadhu; Cheryl W O'Malley; Carol Manchester; Eric Peterson; Kendall M Rogers Journal: Healthc (Amst) Date: 2014-07-22
Authors: Amy C Donihi; Jolynn M Gibson; Michelle L Noschese; Monica M DiNardo; Glory L Koerbel; Michelle Curll; Mary T Korytkowski Journal: Endocr Pract Date: 2011 Jul-Aug Impact factor: 3.443
Authors: Robert J Rushakoff; Mary M Sullivan; Heidemarie Windham MacMaster; Arti D Shah; Alvin Rajkomar; David V Glidden; Michael A Kohn Journal: Ann Intern Med Date: 2017-03-28 Impact factor: 25.391
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