Impact of endocrine and diabetes team consultation on hospital length of stay for patients with diabetes

Levetan, Claresa; Salas, Jacqueline; Wilets, Ilene; Zumoff, Barnett

doi:10.1016/s0002-9343(99)80100-4

Cited by 199 publications

(103 citation statements)

References 5 publications

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“…Some of these efforts have been studied and some have been successful in their efforts. 13,14,[20][21][22][23] Unfortunately, most of these programs have not rigorously assessed their impact on process and outcomes, and the most effective studies published to date have involved interventions much more intensive than those described here. For example, Rush University's intervention was associated with a 50 mg/dL decrease in mean blood glucose but involved an endocrinologist rounding twice daily with house officers for 2 weeks at a time.…”

Section: Discussionmentioning

confidence: 99%

Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Results of a clinical trial

Schnipper

Ndumele

Liang

et al. 2009

Journal of Hospital Medicine

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BACKGROUND:Inpatient hyperglycemia is associated with poor patient outcomes. It is unknown how best to implement glycemic management strategies in the non–intensive care unit (ICU) setting.OBJECTIVE:To determine the effects of a multifaceted quality improvement intervention on the management of medical inpatients with diabetes mellitus or hyperglycemia.DESIGN:Before‐after trial.SETTING:Geographically localized general medical service staffed by physician's assistants (PAs) and hospitalists.PATIENTS:Consecutively enrolled patients with type 2 diabetes or inpatient hyperglycemia.INTERVENTION:A detailed subcutaneous insulin protocol, an admission order set built into the hospital's computerized order entry system, and case‐based educational workshops and lectures to nurses, physicians, and PAs.MEASUREMENTS:Mean percent of glucose readings per patient between 60 and 180 mg/dL; percent patient‐days with hypoglycemia; insulin use patterns; and hospital length of stay.RESULTS:The mean percent of readings per patient between 60 and 180 mg/dL was 59% prior to the intervention and 65% afterward (adjusted effect size 9.7%; 95% confidence interval [CI], 0.6%‐18.8%). The percent of patient days with any hypoglycemia was 5.5% preintervention and 6.1% afterward (adjusted odds ratio 1.1; 95% CI, 0.6–2.1). Use of scheduled nutritional insulin increased from 40% to 75% (odds ratio 4.5; 95% CI, 2.0–9.9) and adjusted length of stay decreased by 25% (95% CI, 9%‐44%). Daily insulin adjustment did not improve, nor did glucose control beyond hospital day 3.CONCLUSIONS:This multifaceted intervention, which was easy to implement and required minimal resources, was associated with improvements in both insulin ordering practices and glycemic control among non‐ICU medical patients. Journal of Hospital Medicine 2009;4:16–27. © 2009 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Results of a clinical trial

Schnipper

Ndumele

Liang

et al. 2009

Journal of Hospital Medicine

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“…However, as the vast majority of the subjects were considered to be Japanese, this factor would only have a minor impact on the results. A number of studies have revealed that care by a multidisciplinary diabetes team can reduce length of stay and improve the process of care among diabetic inpatients (12)(13)(14)(15). For example, Davies et al (15), reported that intervention of a diabetes specialist nursing service in a university hospital, which cost £38.94 per patient, significantly reduced the length of hospital stay by about 3 days (11.0 vs. 8.0 days) and lowered the mean cost per admission by £436.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Type 2 Diabetes among Acute Inpatients and Its Impact on Length of Hospital Stay in Japan

et al. 2011

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Objective The goal of this study was to determine the prevalence of type 2 diabetes among acute inpatients and evaluate its impact on the length of hospital stay in Japan. Research Design and Methods The discharge records of 2,120,170 acute inpatients who were 30 years old or older and discharged between July and December of 2008 were obtained from the Japanese administrative case-mix system, Diagnosis Procedure Combination (DPC), and allocated for analysis. Type 2 diabetes was defined by E11 of the ICD-10 coding system on patient records. Other types of diabetes, including type 1 diabetes and diabetes in pregnancy (defined by ICD-10 codes E10 E12-14 and O24, respectively) were excluded from the analyses. Results Type 2 diabetes was observed among 11.4% of the records, 9.9% of which were cases of diabetes as a comorbidity. Total length of hospital stay was 33,468,152 days, with diabetes patients occupying 13.9% of the total bed days. Patients with type 2 diabetes as a comorbidity had prolonged lengths of hospital stay compared to patients free from diabetes, and stratification by sex, age, surgical treatment, and disease category did not alter these results. The median length of hospital stay was 9 days among patients without diabetes and 13 days among patients with diabetes. Conclusion Japanese acute health care is experiencing an epidemic of type 2 diabetes, with 1 out of 10 acute inpatients suffering from the disease. Complication of type 2 diabetes is associated with prolonged length of hospital stay.

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“…Of note, LOS correlated significantly (P < .0001) with time from admission to consultation, such that each 1-day delay in consultation resulted in a 1-day increase in length of stay. 7 Admittedly, the magnitude of reduction in LOS that is currently feasible through implementation of glycemic control teams is likely less than was possible a decade ago.…”

Section: Reduction In Length Of Stay and Readmissionsmentioning

confidence: 99%

Practical strategies for developing the business case for hospital glycemic control teams

Magee¹,

Beck²

2008

J. Hosp. Med.

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Impact of endocrine and diabetes team consultation on hospital length of stay for patients with diabetes

Cited by 199 publications

References 5 publications

Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Results of a clinical trial

Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Results of a clinical trial

Prevalence of Type 2 Diabetes among Acute Inpatients and Its Impact on Length of Hospital Stay in Japan

Practical strategies for developing the business case for hospital glycemic control teams

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