Impact of Multidisciplinary Process Improvement Interventions on Glucometrics in a Noncritically Ill Setting |
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| Affiliation: | 1. Department of Medicine, North Central Bronx Hospital, Bronx, New York;2. Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, Virginia;3. Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, New York;4. Pharmacy, North Central Bronx Hospital, Bronx, New York;5. Office of Population Health, NYC Health + Hospitals, New York, New York.;1. From the Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota.;1. From the Endocrine Institute, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel;2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.;1. From the Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas;2. Global Diabetes Program, Parkland Health and Hospital Systems, Dallas, Texas;3. Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas. |
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| Abstract: | Objective: This study aimed to assess the impact of multidisciplinary process improvement interventions on glycemic control in the inpatient setting of an urban community hospital, utilizing the daily simple average as the primary glucometric measure.Methods: From 2010–2014, five process of care interventions were implemented in the noncritical care inpatient units of the study hospital. Interventions included education of medical staff, implementation of hyperglycemia and hypoglycemia protocols, computerized insulin order entry, and coordination of meal tray delivery with finger stick and insulin administration. Unpaired t tests compared pre- and postintervention process measures. Simple average daily glucose measure was the primary glucometric outcome. Secondary outcome measures included frequency of hyperglycemia and hypoglycemia. Glucose outcomes were compared with an in-network hospital that did not implement the respective interventions.Results: A total of 180,431 glucose measurements were reported from 4,705 and 4,238 patients from the intervention and comparison hospitals, respectively. The time between bolus-insulin administration and breakfast tray delivery was significantly reduced by 81.7 minutes (P<.00005). The use of sliding scale insulin was sustainably reduced. Average daily glucose was reduced at both hospitals, and overall rates of hypoglycemia were low.Conclusion: A multidisciplinary approach at an urban community hospital with limited resources was effective in improving and sustaining processes of care for improved glycemic control in the noncritical care, inpatient setting.Abbreviations: IQR = interquartile range; JMC = Jacobi Medical Center; NCBH = North Central Bronx Hospital |
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