• Clinical Evidence

Comparison of Computer and Paper-Based Protocols for Managing Hyperglycemia in Critical Ill Patients

Setting: 576-bed tertiary care teaching hospital and Level 1 trauma center.

Objective

This retrospective cohort study compares use of paper-based insulin protocols to a computer-based insulin protocol (EndoTool) for intensive care unit patients.

Setting

576-bed tertiary care teaching hospital and Level 1 trauma center.

Results

  • Among non-cardiothoracic surgery patients in a surgical ICU, mean glucose was lower with EndoTool (127.2 vs 142.9 mg/dL), incidence of hyperglycemia was lower (8.5% vs 28.5% of patients with 10% or more of blood glucose measurements >=200 mg/dL) and incidence of severe hypoglycemia was lower (0.00% vs 0.34% of blood glucose measurements <40 mg/dL per 100 person days).
  • Among cardiothoracic surgery patients in a surgical ICU, mean glucose was lower with EndoTool (130.9 vs 138.8 mg/dL), incidence of hyperglycemia was lower (6.2% vs 15.5% of patients with 10% or more of blood glucose measurements >=200 mg/dL), and incidence of severe hypoglycemia was the same (0.00% of blood glucose measurements <40 mg/dL per 100 person days).
  • Among all other ICU patients, including medical, trauma and neuroscience, mean glucose was lower with EndoTool (141.5 vs 159.9 mg/dL), incidence of hyperglycemia was lower (35.2% vs 64.1% of patients with 10% or more of blood glucose measurements >=200 mg/dL), and incidence of severe hypoglycemia was lower (0.00% vs 0.34% of blood glucose measurements <40 mg/dL per 100 person days).

Conclusions

Use of a computer-based insulin protocol (EndoTool) for intensive care unit patients is associated with lower mean glucose and much higher performance at minimizing hyperglycemia than paper-based protocols; and for the majority of patients, it is associated with significantly decreased glucose variability and lower incidence of severe hypoglycemia.
Objective

This retrospective cohort study compares use of paper-based insulin protocols to a computer-based insulin protocol (EndoTool) for intensive care unit patients.

Setting

576-bed tertiary care teaching hospital and Level 1 trauma center.

Results
  • Among non-cardiothoracic surgery patients in a surgical ICU, mean glucose was lower with EndoTool (127.2 vs 142.9 mg/dL), incidence of hyperglycemia was lower (8.5% vs 28.5% of patients with 10% or more of blood glucose measurements >=200 mg/dL) and incidence of severe hypoglycemia was lower (0.00% vs 0.34% of blood glucose measurements <40 mg/dL per 100 person days).
  • Among cardiothoracic surgery patients in a surgical ICU, mean glucose was lower with EndoTool (130.9 vs 138.8 mg/dL), incidence of hyperglycemia was lower (6.2% vs 15.5% of patients with 10% or more of blood glucose measurements >=200 mg/dL), and incidence of severe hypoglycemia was the same (0.00% of blood glucose measurements <40 mg/dL per 100 person days).
  • Among all other ICU patients, including medical, trauma and neuroscience, mean glucose was lower with EndoTool (141.5 vs 159.9 mg/dL), incidence of hyperglycemia was lower (35.2% vs 64.1% of patients with 10% or more of blood glucose measurements >=200 mg/dL), and incidence of severe hypoglycemia was lower (0.00% vs 0.34% of blood glucose measurements <40 mg/dL per 100 person days).
Conclusions

Use of a computer-based insulin protocol (EndoTool) for intensive care unit patients is associated with lower mean glucose and much higher performance at minimizing hyperglycemia than paper-based protocols; and for the majority of patients, it is associated with significantly decreased glucose variability and lower incidence of severe hypoglycemia.

References

Authors

Andrew Peckham.

Source

Published in OHSU Digital Collections.

Year

2015

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Objective
Setting
Results
Conclusions
References
Objective

This retrospective cohort study compares use of paper-based insulin protocols to a computer-based insulin protocol (EndoTool) for intensive care unit patients.

Setting

576-bed tertiary care teaching hospital and Level 1 trauma center.

Results
  • Among non-cardiothoracic surgery patients in a surgical ICU, mean glucose was lower with EndoTool (127.2 vs 142.9 mg/dL), incidence of hyperglycemia was lower (8.5% vs 28.5% of patients with 10% or more of blood glucose measurements >=200 mg/dL) and incidence of severe hypoglycemia was lower (0.00% vs 0.34% of blood glucose measurements <40 mg/dL per 100 person days).
  • Among cardiothoracic surgery patients in a surgical ICU, mean glucose was lower with EndoTool (130.9 vs 138.8 mg/dL), incidence of hyperglycemia was lower (6.2% vs 15.5% of patients with 10% or more of blood glucose measurements >=200 mg/dL), and incidence of severe hypoglycemia was the same (0.00% of blood glucose measurements <40 mg/dL per 100 person days).
  • Among all other ICU patients, including medical, trauma and neuroscience, mean glucose was lower with EndoTool (141.5 vs 159.9 mg/dL), incidence of hyperglycemia was lower (35.2% vs 64.1% of patients with 10% or more of blood glucose measurements >=200 mg/dL), and incidence of severe hypoglycemia was lower (0.00% vs 0.34% of blood glucose measurements <40 mg/dL per 100 person days).
Conclusions

Use of a computer-based insulin protocol (EndoTool) for intensive care unit patients is associated with lower mean glucose and much higher performance at minimizing hyperglycemia than paper-based protocols; and for the majority of patients, it is associated with significantly decreased glucose variability and lower incidence of severe hypoglycemia.

References

Authors

Andrew Peckham.

Source

Published in OHSU Digital Collections.

Year

2015

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