Reporting hypoglycaemia as a hospital-acquired complication (HAC): assessing biochemical and clinical validity

Link to article at PubMed

Intern Med J. 2023 May 15. doi: 10.1111/imj.16124. Online ahead of print.


OBJECTIVES: Given treatment-related hypoglycaemia in hospital can lead to adverse outcomes, the Australian Commission on Safety and Quality in Health Care has included hypoglycaemia as reportable hospital-acquired complications (HAC) with financial disincentives. However, designation of hypoglycaemia HACs rely on clinical coding without a defined glucose threshold or clinical context. We assessed the biochemical validity and clinical relevance of hypoglycaemia HACs.

METHODS: We performed a retrospective review on patients discharged from the Northern Health hospitals between March-August 2021 that were designated as experiencing a hypoglycaemia HAC. We assessed cases for biochemically validity (glucose <4.0mmol), clinical context and whether they were treatment-related (treatment with insulin or sulphonylurea). We then compared this cohort to a hospital-wide glucometric survey based on a point prevalence study to determine the proportion of individuals with hypoglycaemic events that were designated as hypoglycaemia HAC.

RESULTS: Two-hundred-fifty-six admissions were coded as hypoglycaemia HAC. Eleven (4%) did not have a biochemically valid episode. Of the valid cases, 34 (14%) were not treated with any glucose-lowering medication (GLM), and 11 (4%) were treated with non-insulin, non-sulphonylurea GLM. Two-hundred admissions (78%) were considered treatment-related HAC. Of 139 individuals with diabetes identified in the hospital-wide point prevalence study, 25 (18%) individuals had biochemical evidence for hypoglycaemia. Twenty-two were treatment-related, of which 68% was not coded as HAC.

CONCLUSION: Given safety and cost implications, designation of hypoglycaemia HAC requires a standardised definition incorporating a biochemical threshold and clinical context. We propose a clinically relevant definition of hypoglycaemia HAC to promote safe diabetes care. This article is protected by copyright. All rights reserved.

PMID:37183584 | DOI:10.1111/imj.16124

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