Improving Glycemic Control Safely in Non-Critical Care Patients: A Collaborative Systems Approach in Nine Hospitals.

Area of Science:

• Hospital Quality Improvement
• Endocrinology
• Patient Safety

Background:

• Practice variations in insulin management and glycemic adverse events prompted a nine-hospital collaboration.
• The initiative aimed to reduce hypoglycemia, uncontrolled hyperglycemia, and improve overall glycemic control.

Purpose of the Study:

• To implement and assess a collaborative effort to improve insulin management and glycemic control across multiple hospitals.
• To reduce rates of hypoglycemia and hyperglycemia in non-critical care adult inpatients.

Main Methods:

• Included non-critical care adult inpatients with at least four point-of-care blood glucose readings over two days.
• Implemented standardized insulin management and hypoglycemia prevention protocols, including order sets, education, expert mentoring, and performance feedback.
• Utilized a 'measure-vention' approach, linking patient data monitoring with concurrent interventions to address care lapses.

Main Results:

• Achieved an 11.4 mg/dL improvement in the day-weighted mean blood glucose for the cohort across all nine sites.
• Reduced severe hyperglycemic days, with the percentage of patient-days with blood glucose >299 mg/dL decreasing from 11.6% to 8.8%.
• Eight sites reduced hypoglycemia by 20% or met top-quartile performance benchmarks, while overall hypoglycemia rates remained stable at 3.6%.

Conclusions:

• Multihospital improvements in glycemic control and severe hyperglycemia are achievable.
• Low-cost toolkits and metrics can effectively enhance glycemic management and patient safety.
• Collaborative efforts can lead to significant positive outcomes in hospital-based diabetes care.