Innovations Reducing Hyper-and Hypo-glycemic events in Inpatients

总结 不受控制的高血糖（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的安全问题，在有和没有 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。 总结葡萄糖控制、低血糖和胰岛素使用模式的报告通常被制定为 控制不佳的住院患者出院后很长时间，因此安全有效 血糖控制的方案仍然大大地未得到充分利用。 我们的目标是建立一个新的基准，安全和有效的血糖控制在非关键的 在两年的时间里照顾好自己。我们将通过引入近实时 葡萄糖控制和用于葡萄糖控制的相关药物的测量，以及使用这些 测量，以刺激对控制不佳和非- 坚持机构认可的“最佳实践”治疗方案。干预措施包括： 由葡萄糖控制专家授权触发咨询，电子和人工警报治疗 医生和真实的时间显示的病人需要改变他们的方案的第一线 提供商监测期间发生不受控制的高血压和低血压的住院患者的百分比 干预年份将与基线绩效进行比较。 这种测量和同时干预的策略，称为测量-预防，将被概述 在工具包中，协助其他机构实现同样的目标。该工具包将广泛 通过医院医学协会和其他基于网络的场所传播，作为一个 涉及各种医疗中心的协作改进工作的核心。

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.