Effects of Computerized Decision Support Systems on Blood Glucose Regulation in Critically Ill Surgical Patients


This prospective study evaluates the impact of implementing a computerized decision support system (EndoTool) for the management of blood glucose in critically ill surgical patients, specifically, patients treated in surgical, neurotrauma, thoracic and cardiac surgical intensive care units as well as a cardiac surgical progressive care unit.


763-bed acute care teaching and research hospital.

  • Mean aggregate incidence of hypoglycemia <40 mg/dL decreased 95% with EndoTool, from 1.0% to 0.05% of blood glucose measurements.
  • Mean incidence of hyperglycemia >150 mg/dL decreased 50% with EndoTool, from 33.8% to 16.8% of blood glucose measurements.
  • 12-month rolling mean number of healthcare-associated infections (VAP, CAUTI and CLABSI) decreased 78% with EndoTool.
  • Average number of blood glucose measurements per month decreased 46% with EndoTool.

Implementation of a computerized decision support system (EndoTool) is feasible, has a short learning curve and positively impacts nursing workload by decreasing the total number of blood glucose measurements and eliminating the need for paper protocol calculations; it also directly correlates with reduced incidence of hypoglycemia, hyperglycemia and healthcare-associated infections.


Sandy Fogel, MD, FACS; Christopher Baker, MD, FACS.


Published in Journal of the American College of Surgeons, Volume 216, Issue 4, p828-833.