High value cost conscious care for diabetic patients at a community hospital

Abstract

At New York Methodist Hospital (Brooklyn, NY), the pattern of ordering glucose testing was studied by a multidisciplinary committee because the medicine residents were placing inpatient chemstrip orders at their own discretion. It was found that chemstrip orders were being placed at inappropriate frequencies, and occasionally on inappropriate patients.The staff and residents were educated on daily rounds in order to achieve the goal of reducing unwarranted fingersticks, consequently increasing patient satisfaction and reducing wasted time, resources, and costs. From April 2014 through March 2015 there were 274,889 fingersticks in the inpatient setting and following the intervention the number of fingersticks had decreased to 238,187, representing a significant decrease.

Inpatient Management of Type 2 Diabetes

“…One approach to high-value FSBG monitoring is highlighted in a quality improvement project at New York Methodist Hospital (Brooklyn, New York) in which the Yale Diabetic Center recommendations for inpatient diabetic management were used to reduce unnecessary FSBG checks. 3,4 First, an order set rule was placed that required all patients not in the intensive care unit in the main medical segments of the hospital to receive a definitive diagnosis of diabetes for QACHS finger sticks to be ordered. Daily education was then provided to reduce the frequency of finger sticks to twice daily if the patient was stable with well-controlled blood glucose levels without SSI requirements after 48 hours.…”

“…The number of finger sticks decreased from nearly 275 000 per year to 238 187 during the year after intervention. 4 Additionally, a study at Mount Sinai Medical Center (Chicago, Illinois) on FSBG monitoring found that an estimated 4 to 10 minutes of staff time was required to go to a patient's room and complete a single FSBG. 5 Taken together, these projects highlight the potential of improving patient care by reducing the frequency of an uncomfortable test, as well as the use of hospital supplies and nursing/staff time.…”

“…Daily education was then provided to reduce the frequency of finger sticks to twice daily if the patient was stable with well-controlled blood glucose levels without SSI requirements after 48 hours. The number of finger sticks decreased from nearly 275 000 per year to 238 187 during the year after intervention . Additionally, a study at Mount Sinai Medical Center (Chicago, Illinois) on FSBG monitoring found that an estimated 4 to 10 minutes of staff time was required to go to a patient’s room and complete a single FSBG .…”