The Impact of Nursing and Advanced Practice Clinicians on the Implementation and Outcomes of an Inpatient Glucose Management Program

Kemmerer, Theresa; Bashura, Holly; Dintzis, Joanne; Mathioudakis, Nestoras; Golden, Sherita Hill

doi:10.1177/2325160315598937

Cited by 10 publications

(11 citation statements)

References 12 publications

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“…By the end of the study period, the IDMS team consisted of one full-time endocrinologist, four parttime endocrinologists and one part-time nurse practitioner. [19,20], was established in January 2016. It incorporated nursing staff from most hospital units.…”

Section: Implementation Of the Idmsmentioning

confidence: 99%

Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

Mandel

Langan

Mathioudakis

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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Background: Hospitalized patients with diabetes are at risk of complications and longer length of stay (LOS). Inpatient Diabetes Management Services (IDMS) are known to be beneficial; however, their impact on patient care measures in community, non-teaching hospitals, is unknown. Objectives: To evaluate whether co-managing patients with diabetes by the IDMS team reduces LOS and 30-day readmission rate (30DR). Methods: This retrospective quality improvement cohort study analyzed LOS and 30DR among patients with diabetes admitted to a community hospital. The IDMS medical team consisted of an endocrinologist, nurse practitioner, and diabetes educator. The comparison group consisted of hospitalized patients with diabetes under standard care of attending physicians (mostly internal medicine-trained hospitalists). The relationship between study groups and outcome variables was assessed using Generalized Estimating Equation models. Results: 4,654 patients with diabetes (70.8 ± 0.2 years old) were admitted between January 2016 and May 2017. The IDMS team co-managed 18.3% of patients, mostly with higher severity of illness scores (p < 0.0001). Mean LOS in patients co-managed by the IDMS team decreased by 27%. Median LOS decreased over time in the IDMS group (p = 0.046), while no significant decrease was seen in the comparison group. Mean 30DR in patients comanaged by the IDMS decreased by 10.71%. Median 30DR decreased among patients comanaged by the IDMS (p = 0.048). Conclusions: In a community hospital setting, LOS and 30DR significantly decreased in patients co-managed by a specialized diabetes team. These changes may be translated into considerable cost savings.

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Section: Implementation Of the Idmsmentioning

confidence: 99%

Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

Mandel

Langan

Mathioudakis

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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“…Following the establishment of hospitalwide glucose management policies and order sets for hypoglycemia and hyperglycemia, the nursing diabetes superuser education program, and clinical decision support tools for prescribers, there was a significant and sustained reduction in the incidence of hypoglycemia (~20%) over a three-year time period. 3,11 However, the incidence of severe hyperglycemia was not significantly reduced by these interventions, 3,11 indicating a differential impact of the program on hyperglycemia compared to hypoglycemia. We believe that this disparity was due to the hypoglycemia policy being implemented by the nursing staff, whereas the hyper-glycemia policy and order set were implemented by prescribers (for example, house staff, hospitalists).…”

Section: Resultsmentioning

confidence: 96%

A Gap Analysis Needs Assessment Tool to Drive a Care Delivery and Research Agenda for Integration of Care and Sharing of Best Practices Across a Health System

Golden¹,

Hager

Gould

et al. 2017

The Joint Commission Journal on Quality and Patient Safety

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Background: In a complex health system, it is important to establish a systematic and data-driven approach to identifying needs. The Diabetes Clinical Community (DCC) of Johns Hopkins Medicine’s Armstrong Institute for Patient Safety and Quality developed a gap analysis tool and process to establish the system’s current state of inpatient diabetes care. Methods: The collectively developed tool assessed the following areas: program infrastructure; protocols, policies, and order sets; patient and health care professional education; and automated data access. For the purposes of this analysis, gaps were defined as those instances in which local resources, infrastructure, or processes demonstrated a variance against the current national evidence base or institutionally defined best practices. Results: Following the gap analysis, members of the DCC, in collaboration with health system leadership, met to identify priority areas in order to integrate and synergize diabetes care resources and efforts to enhance quality and reduce disparities in care across the system. Key gaps in care identified included lack of standardized glucose management policies, lack of standardized training of health care professionals in inpatient diabetes management, and lack of access to automated data collection and analysis. These results were used to gain resources to support collaborative diabetes health system initiatives and to successfully obtain federal research funding to develop and pilot a pragmatic diabetes educational intervention. Conclusion: At a health system level, the summary format of this gap analysis tool is an effective method to clearly identify disparities in care to focus efforts and resources to improve care delivery.

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“…This finding was somewhat unexpected and may reflect less centralized glucose management programs and nursing education around the topic of hypoglycemia compared to large academic medical centers. In our academic hospitals, we have dedicated inpatient diabetes management services, which provide not only direct patient care but also extensive education and outreach to nursing staff 29,30 regarding hypoglycemia prevention and management. At our community hospitals, most inpatients are managed by hospitalists who may have less expertise compared to inpatient diabetes specialists in adjusting insulin to prevent hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Time-to-Repeat Point-of-Care Glucose Following Hypoglycemic Events in Hospitalized Patients

Abusamaan

Klonoff

Mathioudakis

2019

J Diabetes Sci Technol

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Background: Previous studies have shown low adherence to the recommendation to repeat point-of-care glucose (POCG) within 15 minutes following the treatment of inpatient hypoglycemia. We sought to evaluate whether patient and clinical factors may predict time-to-repeat (TTR) POCG following hypoglycemic events in hospitalized adult patients. Methods: This was a retrospective cross-sectional analysis of 22 226 index hypoglycemic (≤70 mg/dL) readings (of 993 395 total POCG samples) from 6226 hospital admissions within the Johns Hopkins Health System over three years. Time-to-repeat was defined as the difference in time (minutes) between the index POCG and the next POCG sample. Multivariable logistic regression was used to evaluate the association of TTR with clinical, patient, and hospital factors. Results: The median (IQR) TTR was 49 (25-119) minutes, and 14.1% of index POCGs had a TTR ≤15. Severity of hypoglycemia, intensive care unit (ICU), intermediate care (IMC) and pediatrics admissions, and dextrose or glucagon administration were associated with higher adjusted odds of TTR ≤15 minutes. Admission to community hospitals, procedural units, surgery, and labor and delivery was associated with lower adjusted odds of TTR ≤15 minutes. Age, sex, insulin on board, secretagogue use, diabetes type, nutritional status, previous POCG value, and glycemic variability were not significantly associated. Conclusion: There is low adherence to the recommendation to repeat a POCG within 15 minutes following the treatment of inpatient hypoglycemia, which may be mediated by both patient and hospital factors. Further studies are needed to understand the mediators and implications of this practice variability.

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The Impact of Nursing and Advanced Practice Clinicians on the Implementation and Outcomes of an Inpatient Glucose Management Program

Cited by 10 publications

References 12 publications

Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

A Gap Analysis Needs Assessment Tool to Drive a Care Delivery and Research Agenda for Integration of Care and Sharing of Best Practices Across a Health System

Predictors of Time-to-Repeat Point-of-Care Glucose Following Hypoglycemic Events in Hospitalized Patients

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