Innovations Reducing Hyper-and Hypo-glycemic events in Inpatients

摘要 失控的高血糖(高血糖水平)和医源性低血糖(低血糖 水平)是医院中公认的和普遍存在的安全问题，无论是患有还是不患有 糖尿病。这些在很大程度上可以预防的疾病与长期住院有关， 感染率增加、脱水、电解质紊乱和其他不良后果。 总结血糖控制、低血糖和胰岛素使用模式的报告通常是制定的 控制不佳的住院患者出院后很长时间，因此安全有效 控制血糖的治疗方案仍未得到充分利用。 我们的目标是为非危重患者建立安全有效的血糖控制的新基准 为期两年的护理环境。我们将通过引入近乎实时的 测量血糖控制和用于血糖控制的相关药物，并使用这些 刺激对控制不佳和非 坚持机构认可的“最佳做法”治疗方案。这些干预措施包括 授权触发血糖控制专家会诊，电子和人体治疗警报 医生，以及需要改变治疗方案的患者的实时显示到第一线 供应商。接受监测的住院患者中未控制的高血糖和低血糖患者的百分比 干预年限将与基线业绩进行比较。 我们将概述这种测量和同时干预的策略，称为测量-预防 在工具包方面，协助其他机构实现同样的目标。该工具包将被广泛使用 通过医院医学协会和其他基于网络的场所传播，充当 协作改进工作的中心，涉及多种医疗中心。

Summary Uncontrolled hyperglycemia (high glucose levels) and iatrogenic hypoglycemia (low blood glucose levels) are both recognized and pervasive safety issues in the hospital, in patients with and without diabetes. These largely preventable conditions are associated with prolonged hospital stays, increased infection rates, dehydration, electrolyte disturbances, and other undesirable outcomes. Reports summarizing glucose control, hypoglycemia, and insulin use patterns typically are formulated long after the inpatients with suboptimal control have been discharged, thus safe and effective regimens for glycemic control remain vastly underutilized. Our objective is establish a new benchmark for safe and effective glycemic control in the non-critical care setting over a two year period. We will achieve this goal by introducing near real-time measurement of glucose control and related medications used for glucose control, and using these measurements to spur concurrent interventions on patients who are poorly controlled and non- adherent to institutionally endorsed "best practice" treatment regimens. The interventions include pre- authorized triggered consultation by glucose control experts, electronic and human alerts to treating physicians, and real time displays of patients requiring a change in their regimen to the front line providers. The percentage of monitored inpatients with uncontrolled hyper- and hypo- glycemia during the intervention years will be compared to the baseline performance. This strategy of measurement and concurrent intervention, termed measure-vention, will be outlined in toolkits, assisting other institutions to achieve the same objective. The toolkit will be widely disseminated via the Society of Hospital Medicine and other web based venues, acting as a centerpiece for collaborative improvement efforts involving a wide variety of medical centers.