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

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.