Prevention of inpatient hypoglycemia with a real‐time informatics alert. Issue 10 (5th June 2014)

• Record Type: Journal Article
• Authors: Kilpatrick, C. Rachel; Elliott, Michael B.; Pratt, Elizabeth; Schafers, Stephen J.; Blackburn, Mary Clare; Heard, Kevin; McGill, Janet B.; Thoelke, Mark; Tobin, Garry S.
• Is Part Of: Journal of hospital medicine. Volume 9:Issue 10(2014)
• Page Start: 621
• Page End: 626
• Publication Date: 2014-06-05
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.1002/jhm.2221
• Languages: English
• ISSNs: 1553-5592

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jhm2221-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>Severe hypoglycemia (SH), defined as a blood glucose (BG) <40 mg/dL, is associated with an increased risk of adverse clinical outcomes in inpatients.</p> </sec> <sec id="jhm2221-sec-0002" sec-type="section"> <title>OBJECTIVE</title> <p>To determine whether a predictive informatics hypoglycemia risk‐alert supported by trained nurse responders would reduce the incidence of SH in our hospital.</p> </sec> <sec id="jhm2221-sec-0003" sec-type="section"> <title>DESIGN</title> <p>A 5‐month prospective cohort intervention study.</p> </sec> <sec id="jhm2221-sec-0004" sec-type="section"> <title>SETTING</title> <p>Acute care medical floors in a tertiary care academic hospital in St. Louis, Missouri.</p> </sec> <sec id="jhm2221-sec-0005" sec-type="section"> <title>PATIENTS</title> <p>From 655 inpatients on designated medical floors with a BG of <90 mg/dL, 390 were identified as high risk for hypoglycemia by the alert system.</p> </sec> <sec id="jhm2221-sec-0006" sec-type="section"> <title>MEASUREMENTS</title> <p>The primary outcome was the incidence of SH occurring in high‐risk intervention versus high‐risk control patients. Secondary outcomes included: number of episodes of SH in all study patients, incidence of BG < 60 mg/dL and severe hyperglycemia with a BG >299 mg/dL, length of stay, transfer to a higher level of care, the frequency that high‐risk patient's orders were changed in response to the alert‐intervention process, and mortality.</p> </sec> <sec id="jhm2221-sec-0007" sec-type="section"> <title>RESULTS</title> <p>The alert process, when augmented by nurse‐physician collaboration, resulted in a significant decrease by 68% in the rate of SH in alerted high‐risk patients versus nonalerted high‐risk patients (3.1% vs 9.7%, <italic>P</italic> = 0.012). Rates of hyperglycemia were similar on intervention and control floors at 28% each. There was no difference in mortality, length of stay, or patients requiring transfer to a higher level of care.</p> </sec> <sec id="jhm2221-sec-0008" sec-type="section"> <title>CONCLUSION</title> <p>A real‐time predictive informatics‐generated alert, when supported by trained nurse responders, significantly reduced inpatient SH. <italic>Journal of Hospital Medicine</italic> 2014;9:621–626. © 2014 Society of Hospital Medicine</p> </sec> </abstract>