Colin J Crilly1, Amy J Allen2, Teresa M Amato3, Allison Tiberio4, Rifka C Schulman5, Robert A Silverman6. 1. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States. 2. State University of New York Downstate College of Medicine, Brooklyn, NY 11203, United States. 3. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States; Long Island Jewish Medical Center, Department of Emergency Medicine, Northwell Health, New Hyde Park, NY 11040, United States. 4. Long Island Jewish Medical Center, Department of Emergency Medicine, Northwell Health, New Hyde Park, NY 11040, United States. 5. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States; Long Island Jewish Medical Center, Division of Endocrinology, Department of Medicine, Northwell Health, New Hyde Park, NY 11040, United States. 6. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States; Long Island Jewish Medical Center, Department of Emergency Medicine, Northwell Health, New Hyde Park, NY 11040, United States. Electronic address: rsilverman@northwell.edu.
Abstract
OBJECTIVE: To determine whether hyperglycemic patients can be successfully managed in the Emergency Department Observation Unit (EDOU), as determined by the frequency of inpatient admission following their EDOU stay. METHODS: This was a retrospective chart review of patients≥18years presenting to an academic tertiary care ED between May 1, 2014 and May 31, 2016, found to have a glucose≥300mg/dL, and selected for EDOU admission. Patient demographic information, lab results including an HbA1c, disposition, and hospital revisits within 30days of discharge were recorded. RESULTS: There were 124 EDOU patients meeting criteria. A total of 98/124 (79.0%) had a history of type 1 or 2 diabetes, and 26/124 (21.0%) were newly diagnosed with diabetes in the EDOU. The mean initial ED serum glucose was 467±126mg/dL. Of the 119 patients with HbA1c analyzed, the mean value was 12.1±2.2% (109±24mmol/mol) and in 112/119 (94.1%) the level was ≥9.0% (75mmol/mol). Overall, 104/124 (83.9%) were discharged from the EDOU, 18/124 (14.5%) were admitted to the inpatient service, and 2/124 (1.6%) left the EDOU against medical advice. A total of 7/124 (5.6%) patients returned to the ED within 30days of discharge with hypoglycemia, hyperglycemia, or diabetic ketoacidosis, 6/7 (85.7%) of whom had been discharged from the EDOU. CONCLUSIONS: Results suggest hyperglycemic patients selected by ED physicians can be managed in the EDOU setting. Nearly all patients managed in the EDOU for hyperglycemia had an HbA1c≥9.0%, suggesting unrecognized or poorly controlled chronic diabetes as the basis for hyperglycemia.
OBJECTIVE: To determine whether hyperglycemicpatients can be successfully managed in the Emergency Department Observation Unit (EDOU), as determined by the frequency of inpatient admission following their EDOU stay. METHODS: This was a retrospective chart review of patients≥18years presenting to an academic tertiary care ED between May 1, 2014 and May 31, 2016, found to have a glucose≥300mg/dL, and selected for EDOU admission. Patient demographic information, lab results including an HbA1c, disposition, and hospital revisits within 30days of discharge were recorded. RESULTS: There were 124 EDOU patients meeting criteria. A total of 98/124 (79.0%) had a history of type 1 or 2 diabetes, and 26/124 (21.0%) were newly diagnosed with diabetes in the EDOU. The mean initial ED serum glucose was 467±126mg/dL. Of the 119 patients with HbA1c analyzed, the mean value was 12.1±2.2% (109±24mmol/mol) and in 112/119 (94.1%) the level was ≥9.0% (75mmol/mol). Overall, 104/124 (83.9%) were discharged from the EDOU, 18/124 (14.5%) were admitted to the inpatient service, and 2/124 (1.6%) left the EDOU against medical advice. A total of 7/124 (5.6%) patients returned to the ED within 30days of discharge with hypoglycemia, hyperglycemia, or diabetic ketoacidosis, 6/7 (85.7%) of whom had been discharged from the EDOU. CONCLUSIONS: Results suggest hyperglycemicpatients selected by ED physicians can be managed in the EDOU setting. Nearly all patients managed in the EDOU for hyperglycemia had an HbA1c≥9.0%, suggesting unrecognized or poorly controlled chronic diabetes as the basis for hyperglycemia.