Limited communication and management of emergency department hyperglycemia in hospitalized patients.
J Hosp Med. 2009 Jan 12;4(1):45-49
Authors: Ginde AA, Savaser DJ, Camargo CA
BACKGROUND:: Hyperglycemia is often overlooked and unaddressed in hospitalized patients, and early and intensive management may improve outcomes. OBJECTIVE:: To evaluate communication and early management of emergency department (ED) hyperglycemia. METHODS:: This was a retrospective cohort study of patients with an initial serum glucose >/=140 mg/dL at an urban, academic institution. We randomly selected cases from a consecutive sample of ED visits with at least 1 serum glucose result during a 1-year period. We recorded clinical data and compared the content of inpatient and ED-written discharge instructions. RESULTS:: Of the 27,688 initial ED glucose results during the study period, 3517 (13%) were 140-199 mg/dL, and 2304 (8%) values were >/=200 mg/dL. In our sample of 385 patients, 293 (76%) patients were hospitalized. Inpatient or ED discharge instructions informed 36 (10%) patients of their hyperglycemia and 23 (6%) of a plan for further evaluation and management. There was no difference between inpatient and ED instructions for either of these variables (P = 0.73 and 0.16, respectively). Overall, 107 (55%) patients with glucose values 140-199 mg/dL and 31 (16%) patients with glucose >/=200 mg/dL had no prior diabetes diagnosis. Only 61 (16%) received insulin in the ED for their hyperglycemia, and hyperglycemia was charted as a diagnosis in 36 (9%) cases. CONCLUSIONS:: Most ED patients with even mild hyperglycemia were hospitalized. Recognition, communication, and management of ED hyperglycemia were suboptimal and represent a missed opportunity to identify undiagnosed diabetes and to initiate early glycemic control for hospitalized patients. Journal of Hospital Medicine 2009;4:45-49. (c) 2009 Society of Hospital Medicine.
PMID: 19140193 [PubMed - as supplied by publisher]