Innovations Reducing Hyper-and Hypo-glycemic events in Inpatients

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DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Our objectives are to establish a new benchmark for keeping glucose values in acceptable ranges in non-critical care inpatients admitted with diabetes and hyperglycemia (high blood sugars), and to disseminate a web-based toolkit allowing medical centers across the country to achieve the same benchmark. A strategy of "measure-vention" (real-time measurement and identification of patients with uncontrolled glucose spurring timely and innovative interventions, including pre-authorized triggered consultation by glucose control experts and alerts to providers) will be used to accelerate improvement and adoption of protocol-driven best practice regimens and order sets. Because uncontrolled hyperglycemia and iatrogenic hypoglycemia (low sugars) are pervasive and largely preventable safety issues in the hospital associated with prolonged hospital stays, increased infection rates, dehydration, electrolyte disturbances, and other undesirable outcomes, innovations to reduce these conditions with methods portable to other medical centers would be a significant advance in public health.