Carter Shelton1,2, Andrew P Demidowich3,4, Mahsa Motevalli5, Sam Sokolinsky6, Periwinkle MacKay7, Cynthia Tucker7, Cora Abundo8, Eileen Peters8, Roliette Gooding8, Margaret Hackett8, Joyce Wedler9, Lee Ann Alexander10, Luvenia Barry11, Mary Flynn11, Patricia Rios11, Constance Lulu Fulda12, Michelle F Young12, Barbara Kahl13, Eileen Pummer14, Nestoras N Mathioudakis4, Aniket Sidhaye4, Eric E Howell15, Leo Rotello5, Mihail Zilbermint2,4,5. 1. Ambulatory Services, Medical University of South Carolina, Charleston, SC, USA. 2. Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3. Division of Hospital Medicine, Johns Hopkins Community Physicians at Howard County General Hospital, Columbia, MD, USA. 4. Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 5. Division of Hospital Medicine, Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA. 6. JHHS Quality and Clinical Analytics, Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, USA. 7. Department of Nursing Education, Suburban Hospital, Bethesda, MD, USA. 8. Readmission Department, Suburban Hospital, Bethesda, MD, USA. 9. Department of Information Systems, Suburban Hospital, Bethesda, MD, USA. 10. Department of Pharmacy, Suburban Hospital, Bethesda, MD, USA. 11. Community Health and Wellness, Suburban Hospital, Bethesda, MD, USA. 12. Department of Food and Nutrition, Suburban Hospital, Bethesda, MD, USA. 13. Patient and Family Advisory Council, Suburban Hospital, Bethesda, MD, USA. 14. Department of Quality, Safety, and Performance Improvement, Suburban Hospital, Bethesda, MD, USA. 15. Society of Hospital Medicine, Philadelphia, PA, USA.
Abstract
BACKGROUND: Hospitalized patients who are receiving antihyperglycemic agents are at increased risk for hypoglycemia. Inpatient hypoglycemia may lead to increased risk for morbidity, mortality, prolonged hospitalization, and readmission within 30 days of discharge, which in turn may lead to increased costs. Hospital-wide initiatives targeting hypoglycemia are known to be beneficial; however, their impact on patient care and economic measures in community nonteaching hospitals are unknown. METHODS: This retrospective quality improvement study examined the effects of hospital-wide hypoglycemia initiatives on the rates of insulin-induced hypoglycemia in a community hospital setting from January 1, 2016, until September 30, 2019. The potential cost of care savings has been calculated. RESULTS: Among 49 315 total patient days, 2682 days had an instance of hypoglycemia (5.4%). Mean ± SD hypoglycemic patient days/month was 59.6 ± 16.0. The frequency of hypoglycemia significantly decreased from 7.5% in January 2016 to 3.9% in September 2019 (P = .001). Patients with type 2 diabetes demonstrated a significant decrease in the frequency of hypoglycemia (7.4%-3.8%; P < .0001), while among patients with type 1 diabetes the frequency trended downwards but did not reach statistical significance (18.5%-18.0%; P = 0.08). Based on the reduction of hypoglycemia rates, the hospital had an estimated cost of care savings of $98 635 during the study period. CONCLUSIONS: In a community hospital setting, implementation of hospital-wide initiatives targeting hypoglycemia resulted in a significant and sustainable decrease in the rate of insulin-induced hypoglycemia. These high-leverage risk reduction strategies may be translated into considerable cost savings and could be implemented at other community hospitals.
BACKGROUND: Hospitalized patients who are receiving antihyperglycemic agents are at increased risk for hypoglycemia. Inpatient hypoglycemia may lead to increased risk for morbidity, mortality, prolonged hospitalization, and readmission within 30 days of discharge, which in turn may lead to increased costs. Hospital-wide initiatives targeting hypoglycemia are known to be beneficial; however, their impact on patient care and economic measures in community nonteaching hospitals are unknown. METHODS: This retrospective quality improvement study examined the effects of hospital-wide hypoglycemia initiatives on the rates of insulin-induced hypoglycemia in a community hospital setting from January 1, 2016, until September 30, 2019. The potential cost of care savings has been calculated. RESULTS: Among 49 315 total patient days, 2682 days had an instance of hypoglycemia (5.4%). Mean ± SD hypoglycemic patient days/month was 59.6 ± 16.0. The frequency of hypoglycemia significantly decreased from 7.5% in January 2016 to 3.9% in September 2019 (P = .001). Patients with type 2 diabetes demonstrated a significant decrease in the frequency of hypoglycemia (7.4%-3.8%; P < .0001), while among patients with type 1 diabetes the frequency trended downwards but did not reach statistical significance (18.5%-18.0%; P = 0.08). Based on the reduction of hypoglycemia rates, the hospital had an estimated cost of care savings of $98 635 during the study period. CONCLUSIONS: In a community hospital setting, implementation of hospital-wide initiatives targeting hypoglycemia resulted in a significant and sustainable decrease in the rate of insulin-induced hypoglycemia. These high-leverage risk reduction strategies may be translated into considerable cost savings and could be implemented at other community hospitals.
Entities:
Keywords:
community hospital; cost savings; diabetes; hypoglycemia; insulin; insulin-induced
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