Evaluating the Effects of Quality and Patient Safety Following Standardization of Diabetes Care in Hospitalized Patients

Presentation Number: SUN 628
Date of Presentation: April 2nd, 2017

Latha Dulipsingh*1, Betsy Gaudian2 and Dorothy Wakefield3
1Saint Francis Hospital and Medical Center, Hartford, CT, CT, 2Saint Francis Hospital and Medical Center, 3University of Connecticut

Abstract

Objectives:  The objective of this study was to evaluate the effects on quality and safety of patient care following hospital- wide staff education and standardization of care for diabetes.

Design and Methods: Hospital wide staff education was initiated in Jan 2014 and completed by Sept 2014. Retrospective data was collected on all patients admitted with the diagnosis of diabetes from April 1st 2014- Dec 31st 2015. We gathered data from 13,729 admissions to Saint Francis Hospital and Medical Center. There was a total of 68841 inpatient days from April 2014-December 2015. All patient admissions with the diagnosis of diabetes and who had point-of care glucose monitoring were selected from every unit in the hospital.

Results: We examined data from 13,729 patients from April 2014 to December 2015. At the beginning of the study, in April 2014, only 26% of patients with DM received HbA1C testing. Regression analyses showed a 2.3% increase per month in the percentage of patients with their HbA1c tested (p<0.001), rising to a high of 69% in October 2015. Over the same time period, there was a 2% decrease per month in the percentage of hyperglycemic events per inpatient day (p<0.01), starting at 172% in April 2014 and dropping to 109% by the end of 2015. Similarly, there was a 0.2% decrease per month in the percentage of hypoglycemic events per inpatient day (p<0.01), starting at 11-14% in early 2014 and dropping to 9.5% by the end of 2015. There was also a 3% increase per month in the percentage of rechecks for hypoglycemia (p<0.001), from 49% in January 2015 to 79% by the end of the year.

Discussion: Our study aimed to evaluate the associations between ongoing implementation of standardized policies/protocols and hospital-wide staff education and its impact on quality and safe coordination of care. Our results demonstrate a significant improvement in the awareness of diabetes leading to increased testing of HbA1c over time, and an improvement in the quality of care as evident by the steady decline in the incidence of hyperglycemic and hypoglycemic events. We attribute this improvement to staff education and standardization of protocols. There was also a steady increase in the percent of blood sugar rechecks following treatment of hypoglycemia. Inpatient hypoglycemia is associated with increased complications and mortality and protocol based treatment and recheck of blood sugars like the one stablished at our hospital is important to improve safe coordination of care for inpatients with diabetes.

 

Nothing to Disclose: LD, BG, DW