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Intraoperative glycemic protocol calculator: automation in the OR.

Nazia Siddiqui1,2, Jee Ha Park3, Charbel Barrak4

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Summary

A web-based Intraoperative Glycemic Protocol Calculator (IGPC) significantly improved provider adherence to cardiac surgery glycemic management protocols. This clinical decision support tool enhanced real-time compliance without increasing adverse glycemic events.

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Area of Science:

  • Cardiology
  • Anesthesiology
  • Medical Informatics

Background:

  • Intraoperative glycemic management is critical during cardiac surgery.
  • Adherence to established protocols can be challenging in high-acuity settings.

Purpose of the Study:

  • To evaluate the impact of a web-based Intraoperative Glycemic Protocol Calculator (IGPC) on provider compliance with glycemic management protocols.
  • To assess changes in adverse glycemic events following IGPC implementation.

Main Methods:

  • A single-center retrospective cohort study compared protocol adherence before and after IGPC implementation in adult cardiac surgery patients.
  • Protocol adherence was defined as appropriate insulin administration within five minutes of glucose measurement.
  • Data were collected from August-October 2022 (pre-intervention) and April-June 2023 (post-intervention).

Main Results:

  • IGPC use significantly increased adherence across all intraoperative phases: Pre-CPB (65.5% to 80.2%), On-CPB (53.0% to 75.1%), and Post-CPB (34.8% to 58.8%).
  • Rates of severe hypoglycemia remained low and unchanged (0.1% in both groups).
  • Intraoperative hyperglycemia rates were similar between pre- and post-intervention phases (4.2% vs. 4.1%).

Conclusions:

  • The IGPC significantly improved real-time adherence to intraoperative glycemic control protocols.
  • The tool enhanced compliance without increasing adverse glycemic events.
  • Clinical decision support tools are valuable for improving protocol compliance in complex surgical procedures.