Perspectives on Diabetes Care

Improving Inpatient Care

Aug 10, 2013, 01:00 AM

I have been so impressed with the number of excellent sessions at AADE this year.  My goal has been to make every inpatient session that I can, and yesterday I heard some wonderful examples of “moving a mountain” to make diabetes safer in the hospital setting!  Not only has the quality of care improved considerably, measured in the AACE goal of time in BG range of ≤ 140-180 mg/dl and reduction in the incidence of hypoglycemia (the elephant in the room so to speak), but also a reduction in length of hospital stay. 

Some stats from the literature shared:

• A patient with two or more blood glucose values greater than 180 mg/dl cost twice as much as those with good control
• The largest component of the total cost for inpatient hospital care is the diagnosis of diabetes (43%)

So what were the components of the programs where quality of care and cost savings improved within the hospital?

• Education for ALL staff – Hospitalists, nurses, nursing administrators, pharmacists, dietary staff (including those delivering trays), IT, laboratory employees [This was a common theme in ALL the sessions]
• Education accomplished through – emails, posters, newsletters, pocket cards, webinars, annual competencies, lunch and learn, unit and physician practice meetings
• At one site a hospital Intranet site was designed with the  IT department with links to diabetes Management Resources within and outside the hospital
• Rounding by an inpatient diabetes educator team who also worked to educate staff one on one at point of care as needed
• Tray tickets with carbohydrate counts and timing on insulin administration
• Analysis of the root cause of severe hypoglycemia, ownership and how to prevent subsequent hypoglycemia both in that patient specifically, and overall within the hospital setting
• Improvement in communication from one shift to another (whether through MD, nurse or diabetes educator handoff)

As the team approach was built through education and programming, significant improvements in diabetes care (reduced hyperglycemia and almost elimination of hypoglycemia) resulted and decreased costs were realized. Inpatient consults increased and in some institutions, this resulted in increased hiring of diabetes educators to maximize the care of the patient with diabetes in the hospital setting and reduce overall costs. 

Once again I had to smile and be delighted to be an educator.  There are a lot of great, innovative and caring educators across the nation focused in leading the changes that will result in the best care possible for the patient, while recognizing the importance of fiscal responsibility.  I salute you all for your passion and diligence, and hope that we all will continue to work towards the day when people with diabetes enter the hospital no longer afraid of what will happen to their BG control when their care is in our hands.

Please share your inpatient success stories with us as we all work towards best practice.