IMPROVING GLYCEMIC CONTROL SAFELY IN CRITICAL CARE PATIENTS A COLLABORATIVE SYSTEMS APPROACH IN NINE HOSPITALS.
Endocr Pract. 2017 Feb 22;:
Authors: Maynard GA, Holdych J, Kendall H, Harrison K, Montgomery PA, Kulasa K
Objective Safely improve glycemic control in the critical care units of nine hospitals. Methods Critical care adult inpatients from nine hospitals with ≥ 4 point-of-care (POC) blood glucose (BG) readings over ≥ 2 days were targeted by collaborative improvement efforts to reduce hyper- and hypo-glycemia. Balanced glucometric goals for each hospital were set targeting improvement from baseline, or goals deemed desirable from Society of Hospital Medicine (SHM) benchmarking data. Collaborative interventions included standardized insulin infusion protocols, hypoglycemia prevention bundles, audit and feedback, education, and measure-vention (coupling measurement of patients "off protocol" with concurrent interventions to correct suboptimal care). Results All sites improved glycemic control. Six reached pre-specified levels of improvement of the day-weighted mean (DWM) BG. The DWM BG for the cohort decreased by 7.7 mg/dL [95% CI 7.0 - 8.4] to 151.3 mg/dL. Six of nine sites showed improvement in the percent ICU days with severe hyperglycemia (any BG > 299 mg/dL). ICU severe hyperglycemic days declined from 8.6% to 7.2% for the cohort [RR 0.84, 95% CI 0.80 - 0.88]. Patient days with any BG < 70 mg / dL were reduced by 0.4% [95% CI 0.06 - 0.6%] from 4.5% to 4.1% for a small but statistically significant reduction in hypoglycemia. Seven of nine sites showed improvement. Conclusion Multi-hospital improvements in ICU glycemic control, severe hyperglycemia, and hypoglycemia are feasible. Balanced goals for glycemic control and hypoglycemia in the ICU using SHM benchmarks and metrics enhanced successful improvement efforts with good staff acceptance and sustainability.
PMID: 28225315 [PubMed - as supplied by publisher]