Improving the Management of Diabetes in Hospitalized Patients: The Results of a Computer-Based House Staff Training Program

Abstract

Background: Poorly controlled diabetes in hospitalized patients is associated with poor clinical outcomes. We hypothesized that computer-based diabetes training could improve house staff knowledge and comfort for the management of diabetes in a large tertiary-care hospital. Results: A significant increase in comfort levels and knowledge in the management of inpatient diabetes was seen among house staff at all levels of training (P < 0.02), but the increase was smaller for senior house staff compared with junior house staff. Nonsignificant trends suggesting increased use of basal-bolus insulin (P = 0.06) and decreased use of sliding-scale insulin (P = 0.10) were seen following the educational intervention in 2009, whereas no such change was seen in 2008 (P > 0.90). Overall, house staff evaluated the training program as ''very relevant'' and the technology interface as ''good.'' Conclusions: A computer-based diabetes training program can improve the comfort and knowledge of house staff and potentially improve their insulin administration practices at large academic centers.

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

“…Vaidya et al . similarly reported statistically non‐significant reductions in subcutaneous ‘sliding scale’ insulin use (25 to 15%) following the introduction of a computerized educational module across the endocrinology department .…”

“…Details of the session content and delivery were not reported in the sufficient detail to allow for further analysis and conclusion. Vaidya et al similarly reported statistically non-significant reductions in subcutaneous 'sliding scale' insulin use (25 to 15%) following the introduction of a computerized educational module across the endocrinology department [56].…”

“…The types of intervention varied, as well as the implementation strategies, and measures of improvement between studies (see Table S4). Although three studies [19] x Courtenay 2007 [17] x x Donihi 2006 [26] x x Dooley 2011 [28] x Donsa 2016 [27] x x Doyle 2014 [54] x x x x Ena 2009 [41] x x Gomez-Huelgas 2014 [55] x x Guerra 2010 [43] x x x Hamilton 2013 [18] x Harbin 2015 [36] x x Helmle 2017 [37] x x x x x x x Horton 2015 [44] x Kowiatek 2001 [29] x x x x Lehnbom 2009 [35] x x Mamillapalli 2012 [38] x Maynard 2009 [45] x x x McIver 2009 [30] x x x Mulla 2015 [39] x x x Newsom 2018 [15] x x x x Noschese 2008m [46] x x Rushmer 2008 [31] x x x Schnipper 2009 [47] x x x Schnipper 2010 [48] x Taylor 2012 [32] x Thompson 2009 [49] x x x Trujillo 2008 [50] x x Tully 2018 [33] x x x Vaidya 2012 [56] x Valgardson 2015 [52] x x Wesorick 2010 [34] x x Wexler 2010 [52] x Wong 2016 [40] x x Yeung 2018 [53] x x ª 2019 Diabetes UK used the UK's National Inpatient Diabetes Audit (NaDIA) methodology and data collection tool, the follow-up period, interventions, implementation and the data reported were varied, hence it was difficult to pool data or make meaningful comparisons [18,19,32]. The introduction of simple, small focused interventions led to an improvement in the completeness and accuracy of insulin prescribing, particularly when they involved 'hard stops' (such as pre-printi...…”

Perspectives on Learning and Clinical Practice Improvement for Diabetes in the Hospital: A Review of Educational Interventions for Providers

“…Our review of these 16 studies included at least 1,123 participants from different disciplines (34–49). These studies were conducted in different countries, including 13 in the United States, 1 in Australia, 1 in the United Kingdom, and 1 in Spain.…”

“…Learners included in the majority of these studies were trainees from internal medicine residency programs (34, 36, 39, 42, 44–46, 49), while fewer participants were from other disciplines. A smaller number were faculty staff, nurses, and other allied health service providers.…”