Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol
Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol
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DOI：
10.1007/s10877-015-9718-3
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发表时间：
2016-06-01
影响因子：
2.2
通讯作者：
Dellinger, E. Patchen
中科院分区：
文献类型：
--
作者：
Nair, Bala G.;Grunzweig, Katherine;Dellinger, E. Patchen
不良的围手术期血糖管理可导致负面的手术结果。改善对血糖控制方案的遵从性可能会导致更好的血糖管理。以麻醉信息管理系统为基础的决策支持系统-智能麻醉管理器(TM)(SAM)被用于向麻醉提供者生成实时提醒，以严格遵守我们的机构葡萄糖管理协议。比较基线期间(12个月)不使用SAM和干预期(12个月)接受SAM决策支持的患者对每小时血糖测量和正确胰岛素剂量调整的依从性。此外，对基线和干预期的血糖管理参数进行了比较。基线期间的1587例和干预期间的1997例符合血糖管理的标准(糖尿病患者或非糖尿病患者的血糖水平为140 mg/dL)。在干预案例中，麻醉提供者选择了48.7%的时间使用SAM提醒，主要是针对患有糖尿病、HbA1C或体重指数较高的患者，而对其余病例禁用该系统。与基线相比，干预期间对每小时血糖测量的依从性和正确的胰岛素剂量显著增加(分别从52.6%到71.2%和13.5%到24.4%)。尽管改善了对机构方案的遵从性，但使用SAM提醒时，平均血糖水平和其他血糖管理参数并未显示出显著改善。实时电子提醒改善了术中对机构血糖管理方案的依从性，尽管血糖参数并没有改善，即使在更符合方案的情况下也是如此。
Poor perioperative glycemic management can lead to negative surgical outcome. Improved compliance to glucose control protocol could lead to better glucose management. An Anesthesia Information Management System based decision support system-Smart Anesthesia Manager (TM) (SAM) was used to generate real-time reminders to the anesthesia providers to closely adhere to our institutional glucose management protocol. Compliance to hourly glucose measurements and correct insulin dose adjustments was compared for the baseline period (12 months) without SAM and the intervention period (12 months) with SAM decision support. Additionally, glucose management parameters were compared for the baseline and intervention periods. A total of 1587 cases during baseline and 1997 cases during intervention met the criteria for glucose management (diabetic patients or non-diabetic patients with glucose level > 140 mg/dL). Among the intervention cases anesthesia providers chose to use SAM reminders 48.7 % of the time primarily for patients who had diabetes, higher HbA1C or body mass index, while disabling the system for the remaining cases. Compliance to hourly glucose measurement and correct insulin doses increased significantly during the intervention period when compared with the baseline (from 52.6 to 71.2 % and from 13.5 to 24.4 %, respectively). In spite of improved compliance to institutional protocol, the mean glucose levels and other glycemic management parameters did not show significant improvement with SAM reminders. Real-time electronic reminders improved intraoperative compliance to institutional glucose management protocol though glycemic parameters did not improve even when there was greater compliance to the protocol.