Objective

This prospective randomized controlled crossover study compares use of a paper-based intravenous insulin protocol to a computer-based intravenous insulin protocol (EndoTool) for patients in a burn intensive care unit.

Setting

Largest (425-bed) U.S. military hospital, academic medical center and Level 1 trauma center.

Results

• Time in the target range of 80-110 mg/dL was higher with EndoTool (47% ± 17 vs 41% ± 16.6).
• Mean blood glucose was lower with EndoTool (113 mg/dL ± 10.2 vs 119 mg/dL ± 14).
• Nursing compliance with the initial infusion calculation was significantly higher with EndoTool (82% ± 17.2 vs 39% ± 15).
• Incidence of hypoglycemia measured as a percentage of blood glucose measurements was lower with EndoTool across all categories: <40 mg/dL (0.09% vs 0.17%), <60 mg/dL (0.68% vs 1.3%) and <80 mg/dL (4.6% vs 8.1%).

Conclusions

Use of EndoTool improves glycemic control over a paper-based protocol for burn intensive care patients, achieving greater time in range, lower mean blood glucose and reduced incidence of hypoglycemia; furthermore, nursing compliance with the initial infusion calculation is more than double with EndoTool than with a paper-based protocol, increasing uniformity in delivery of insulin therapy.