Study: EndoTool Glucose Management System Boosts Vidant Medical Center’s Surgical Care Improvement Project Scores, Doubles Cost Savings in Hospital-Acquired Conditions

A late-breaking poster presented at the 73rd Scientific Sessions of the American Diabetes Association by Greenville, NC-based Vidant Medical Center, the flagship hospital for Vidant Health and the teaching hospital for the Brody School of Medicine at East Carolina University, has demonstrated that implementing the EndoTool Glucose Management System resulted in controlled and sustained improvements in blood sugar levels among patients. The poster, “Successful utilization of a computer-guided glucose management system for a Surgical Care Improvement Project at a tertiary care hospital,” showed that the dramatic advancement helped the hospital achieve 100 percent compliance against Surgical Care Improvement Project (SCIP) Inf-4, which requires cardiac surgery patients to have controlled blood glucose levels of less than or equal to 200 mg/dl) by 6 a.m. on postoperative days one and two. The national average for SCIP Inf-4 compliance is 95 percent.

SCIP is a national quality partnership of organizations interested in improving surgical care by significantly reducing surgical complications. SCIP partners include a steering committee of 10 national organizations that have pledged their commitment and full support for SCIP.

The EndoTool Glucose Management System, from Monarch Medical Technologies, is a market-leading software solution that provides unsurpassed patient-specific glycemic control. The system was first introduced at Vidant in 2008 and progressively deployed across 11 surgical, intensive care and stepdown units in the hospital. Since it was installed, the system has also helped the hospital reduce its rate of Hospital-Acquired Conditions (HAC) 8, defined as manifestations of poor glycemic control, more than 61 percent between 2009 and 2011. The hospital’s HAC-8 rate is now almost half the national average. The Centers for Medicare and Medicaid Services (CMS) has determined that manifestations of poor blood sugar control are reasonably preventable errors for which it may not reimburse hospitals.

“EndoTool has been invaluable in the hospital’s efforts to improve glucose management across Vidant Medical Center,” said Robert J. Tanenberg, MD, FACP, endocrinologist and professor of medicine at East Carolina University, and lead author of the poster. “Not only is Vidant Medical Center now among the top 10 percent of all hospitals nationwide, putting it in line with leading cardiac hospitals such as Cleveland Clinic and Mayo Clinic, but it has also helped the center double its cost savings by preventing CMS-defined Never Events1 caused by poor blood glucose control.”

The study, which involved more than 8,000 patients and 260,000 drawn glucose values, further showed that the average time to target was 3.38 hours for a blood glucose level of 180 mg/dL and 6.65 hours for 130 mg/dL. The poster also reported that rates of hypoglycemia were minimal, with only 0.02 percent of the values less than 40 mg/dL and only 0.86 percent of values less than 70 mg/dL.

“Before implementing EndoTool, blood glucose control was often difficult to achieve,” said Sandra Hardee, PharmD, CDE, diabetes program manager at Vidant Medical Center. “As we started implementing EndoTool in different units of the hospital, we saw significant improvements in the blood glucose levels across each unit. By being able to take into account complex and complicating factors, such as diabetes status, renal function and hyperglycemic emergencies, physicians and nurses were able to quickly achieve optimal blood glucose levels for our patients, which results in fewer complications.”

Prior to 2008, Vidant Medical Center used an alternative commercial, computer-based glucose control system that simply digitized traditional outdated paper-based protocols, relied on relatively simplistic point-to-point calculations and did not permit dynamic dosing adjustments. The EndoTool Glucose Management System is the only glucose management software solution that models, predicts and adapts to each patient’s unique physiology and individual response. With the system’s proprietary model predictive control technology, 99.4 percent of patients achieve control,2 and glucose levels remain within target range as much as 97.25 percent of the time after control is achieved.2

The Vidant Medical Center study comes on the heels of a study published in the Journal of the American College of Surgeons that demonstrated patients on EndoTool Glucose Management System are more likely to have their blood glucose levels in control (<150 mg/dL), and the software frees up valuable nurse time to create better efficiency. The study, conducted at Carilion Roanoke Memorial Hospital, showed that use of the system led to a 45 percent to 57 percent reduction in hyperglycemia episodes (p <0.0001) experienced across all ICUs3 and a 95 percent reduction in serious hypoglycemia episodes (p <0.0001).3 It further reported that use of the system resulted in a 46 percent drop in the total number of blood glucose level measurements each month2 and an overall reduction in the total minutes of time spent by nurses on glucose control.3

“Both the Vidant and the Carilion studies reinforce the tremendous results we have seen other hospitals and health systems achieve when implementing the EndoTool system,” said Wilson Constantine, Monarch CEO. “The beauty of our system is that it is capable of providing unrivaled patient-specific glycemic control across a broad range of patients because it was designed to address unique physiology and individual response. No other program or method takes into account this level of dynamic information.”

About EndoTool Glucose Management System

EndoTool Glucose Management System is the market-leading glucose management software solution for healthcare institutions. It is designed to achieve rapid and sustained control in even the most complex patient cases, including those with sepsis, burns, DKA and HNS. Unlike paper-based and traditional computer-based protocols, EndoTool is the only software solution of its kind that models, predicts and adapts insulin dosing to the individual patient. EndoTool’s proprietary model predictive control technology allows for unsurpassed optimization in patient-specific dosing, significantly improving quality of care, reducing risk and controlling healthcare costs. Moreover, it gives healthcare providers the flexibility they need to support best practices and comply with continuous improvement initiatives. With EndoTool, 99.4% of patients achieve control, and glucose levels remain within target range as much as 97.25% of the time after control is achieved.1

About Vidant Health

Vidant Health, a mission-driven, not-for-profit corporation, owns, leases or has a majority membership interest in nine eastern North Carolina hospitals and has a management agreement with one other. The health system includes Albemarle Health, Vidant Beaufort Hospital, Vidant Bertie Hospital, Vidant Chowan Hospital, Vidant Duplin Hospital, Vidant Edgecombe Hospital, The Outer Banks Hospital, Vidant Medical Center, Vidant Pungo Hospital, Vidant Roanoke-Chowan Hospital, Vidant Home Health and Hospice; Vidant Wellness Centers and physician practices, and is affiliated with the Brody School of Medicine at East Carolina University. On the web at

About Monarch Medical Technologies

Monarch Medical Technologies is a privately held medical technology company founded by clinicians with a vision of dramatically improving hospital-based glucose management by replacing traditional paper and pencil linear protocols with individualized and predictive computer-based solutions. With the launch of its flagship product, the EndoTool Glucose Management System, the company pioneered the field of predictive therapeutic control technologies for managing drugs and processes of concern. Formerly the EndoTool division of Hospira Worldwide, a leading Fortune 1000 healthcare company, the company was strategically acquired in October 2012 by private equity firm Eigen Capital Partners.

  1. Manifestations of Poor Glycemic Control; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Department of Health and Human Services, Centers for Medicare and Medicaid Services. 42 CFR Parts 411, 412, 413, 422, and 489 (19 August 2008) pp. 48433-49084.
  2. Multi-year experience of EndoTool customers; data on file.
  3. Fogel, S, et al. “Effects of Computerized Decision Support Systems on Blood Glucose Regulation in  Critically Ill Surgical Patients.” JACS. 2013; 216 (4):828-833.