• Clinical Evidence

Glucose Management . . . a “Must Have:” Computerized Software Systems Help Boost Outcomes, Reduce Costs

Setting: 325-bed full-service acute care hospital and Lead Level III trauma center.

Objective

This quality improvement initiative compares various glycemic control metrics before and after implementation of a computerized glucose management software system (EndoTool) in critical care, intensive care and step-down units as well as a progressive care unit.

Setting

325-bed full-service acute care hospital and Lead Level III trauma center.

Results

  • Average blood glucose for CABG/valve surgery patients decreased significantly with EndoTool, from 154 to 120 mg/dL on post-operative Day 1, from 157 to 112 mg/dL on post-operative Day 2, and from 156 to 135 mg/dL over the course of the stay (admission to discharge).
  • Percentage of CABG/valve surgery patients who achieved a blood glucose of 70-180 mg/dL increased 18.4% with EndoTool, from 72.7% to 86.1%.
  • Incidence of hyperglycemia >180 mg/dL for CABG/valve surgey patients decreased 53.3% with EndoTool, from 26.6% to 12.4%.
  • Time on intraveous insulin for CABG/valve surgey patients increased significantly with EndoTool, from 16 to 56.7 hours, consistent with industry standard best practice guidelines of at least 48 hours post-operatively.
  • Incidence of hypoglycemia <70 mg/dL in the progressive care unit (treating mild diabetic ketoacidosis, systemic inflammatory response syndrome, simple hyperglycemia, and similar conditions) decreased 81% with EndoTool, from 3.9% to 0.74% of patients, and incidence <50 mg/dL decreased 90%, from 0.9% to 0.09% of patients.
  • Percentage of patients in the progressive care unit who achieved a blood glucose of 70-180 mg/dL increased 14.7% with EndoTool, from 70.8% to 81.2%.
  • Average glucose for the first 24 hours following initiation of a sepsis protocol decreased 10 mg/dL with EndTool, from 157 to 147 mg/dL.
  • Savings in the progressive care unit were estimated at $91,136 over the first six months alone.

Conclusions

A computerized glucose management software system (EndoTool) enables significant improvements in clinical and financial outcomes for patients requiring intravenous insulin and is enthusiastically received by nurses and physicians.

Objective

This quality improvement initiative compares various glycemic control metrics before and after implementation of a computerized glucose management software system (EndoTool) in critical care, intensive care and step-down units as well as a progressive care unit.

Setting

325-bed full-service acute care hospital and Lead Level III trauma center.

Results
  • Average blood glucose for CABG/valve surgery patients decreased significantly with EndoTool, from 154 to 120 mg/dL on post-operative Day 1, from 157 to 112 mg/dL on post-operative Day 2, and from 156 to 135 mg/dL over the course of the stay (admission to discharge).
  • Percentage of CABG/valve surgery patients who achieved a blood glucose of 70-180 mg/dL increased 18.4% with EndoTool, from 72.7% to 86.1%.
  • Incidence of hyperglycemia >180 mg/dL for CABG/valve surgey patients decreased 53.3% with EndoTool, from 26.6% to 12.4%.
  • Time on intraveous insulin for CABG/valve surgey patients increased significantly with EndoTool, from 16 to 56.7 hours, consistent with industry standard best practice guidelines of at least 48 hours post-operatively.
  • Incidence of hypoglycemia <70 mg/dL in the progressive care unit (treating mild diabetic ketoacidosis, systemic inflammatory response syndrome, simple hyperglycemia, and similar conditions) decreased 81% with EndoTool, from 3.9% to 0.74% of patients, and incidence <50 mg/dL decreased 90%, from 0.9% to 0.09% of patients.
  • Percentage of patients in the progressive care unit who achieved a blood glucose of 70-180 mg/dL increased 14.7% with EndoTool, from 70.8% to 81.2%.
  • Average glucose for the first 24 hours following initiation of a sepsis protocol decreased 10 mg/dL with EndTool, from 157 to 147 mg/dL.
  • Savings in the progressive care unit were estimated at $91,136 over the first six months alone.
Conclusions

A computerized glucose management software system (EndoTool) enables significant improvements in clinical and financial outcomes for patients requiring intravenous insulin and is enthusiastically received by nurses and physicians.

References

Authors

Denise Blair, MSN, RN, ACNS-BC, CDE; Laura Zamora, RN; Rodney Brumbelow, PharmD, BCPS; Leo Mercer, MD, FACS.

Source

Published in Nursing Management, Volume 43, Issue 12, p10-12.

Year

2012

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Objective
Setting
Results
Conclusions
References
Objective

This quality improvement initiative compares various glycemic control metrics before and after implementation of a computerized glucose management software system (EndoTool) in critical care, intensive care and step-down units as well as a progressive care unit.

Setting

325-bed full-service acute care hospital and Lead Level III trauma center.

Results
  • Average blood glucose for CABG/valve surgery patients decreased significantly with EndoTool, from 154 to 120 mg/dL on post-operative Day 1, from 157 to 112 mg/dL on post-operative Day 2, and from 156 to 135 mg/dL over the course of the stay (admission to discharge).
  • Percentage of CABG/valve surgery patients who achieved a blood glucose of 70-180 mg/dL increased 18.4% with EndoTool, from 72.7% to 86.1%.
  • Incidence of hyperglycemia >180 mg/dL for CABG/valve surgey patients decreased 53.3% with EndoTool, from 26.6% to 12.4%.
  • Time on intraveous insulin for CABG/valve surgey patients increased significantly with EndoTool, from 16 to 56.7 hours, consistent with industry standard best practice guidelines of at least 48 hours post-operatively.
  • Incidence of hypoglycemia <70 mg/dL in the progressive care unit (treating mild diabetic ketoacidosis, systemic inflammatory response syndrome, simple hyperglycemia, and similar conditions) decreased 81% with EndoTool, from 3.9% to 0.74% of patients, and incidence <50 mg/dL decreased 90%, from 0.9% to 0.09% of patients.
  • Percentage of patients in the progressive care unit who achieved a blood glucose of 70-180 mg/dL increased 14.7% with EndoTool, from 70.8% to 81.2%.
  • Average glucose for the first 24 hours following initiation of a sepsis protocol decreased 10 mg/dL with EndTool, from 157 to 147 mg/dL.
  • Savings in the progressive care unit were estimated at $91,136 over the first six months alone.
Conclusions

A computerized glucose management software system (EndoTool) enables significant improvements in clinical and financial outcomes for patients requiring intravenous insulin and is enthusiastically received by nurses and physicians.

References

Authors

Denise Blair, MSN, RN, ACNS-BC, CDE; Laura Zamora, RN; Rodney Brumbelow, PharmD, BCPS; Leo Mercer, MD, FACS.

Source

Published in Nursing Management, Volume 43, Issue 12, p10-12.

Year

2012

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