Benchmarking Glucose Results through Automation: The 2009 Remote Automated Laboratory System Report

Abstract

Background: Hyperglycemia in the adult inpatient population remains a topic of intense study in U.S. hospitals. Most hospitals have established glycemic control programs but are unable to determine their impact. The 2009 Remote Automated Laboratory System (RALS) Report provides trends in glycemic control over 4 years to 576 U.S. hospitals to support their effort to manage inpatient hyperglycemia. Methods: A proprietary software application feeds de-identified patient point-of-care blood glucose (POC-BG) data from the Medical Automation Systems RALS-Plus data management system to a central server. Analyses include the number of tests and the mean and median BG results for intensive care unit (ICU), non-ICU, and each hospital compared to the aggregate of the other hospitals. Results: More than 175 million BG results were extracted from 2006–2009; 25% were from the ICU. Mean range of BG results for all inpatients in 2006, 2007, 2008, and 2009 was 142.2–201.9, 145.6–201.2, 140.6–205.7, and 140.7–202.4 mg/dl, respectively. The range for ICU patients was 128–226.5, 119.5–219.8, 121.6–226.0, and 121.1–217 mg/dl, respectively. The range for non-ICU patients was 143.4–195.5, 148.6–199.8, 145.2–201.9, and 140.7–203.6 mg/dl, respectively. Hyperglycemia rates of >180 mg/dl in 2008 and 2009 were examined, and hypoglycemia rates of <40 mg/dl (severe) and <70 mg/dl (moderate) in both 2008 and 2009 were calculated. Conclusions: From these data, hospitals can determine the current state of glycemic control in their hospital and in comparison to other hospitals. For many, glycemic control has improved. Automated POC-BG data management software can assist in this effort.

Implementing and Evaluating a Multicomponent Inpatient Diabetes Management Program: Putting Research into Practice

“…This technological advancement allows for (1) timely evaluation of the effects of future interventions on glucometrics; (2) prompt identification of deviations from accepted glucose targets to help guide root cause investigations and development of targeted solutions; and (3) engagement of hospital staff by displaying monthly glucose reports throughout the hospital, coupled with a reward system for units consistently achieving glucose targets. 37,38 To address the current obstacles in accurately and efficiently assessing processes of care relating to glucose management, the GSC is collaborating with the medical information technology department to reconfigure the CPOE and eMAR systems to expand the array and specificity of electronic processes of care documentation, while also facilitating data retrieval for ongoing analyses. In addition to evaluating performance metrics, glucose management programs must determine whether the recommendations are understood, supported, and adhered to, by all relevant members of the hospital care team.…”

A systematic scoping review of the domains and innovations in secondary uses of digitised health-related data

“…The scope of reported secondary uses included for conducting epidemiological and pharmacovigilance research studies, for facilitating recruitment to randomised controlled trials14 – 16 and for carrying out audits and benchmarking studies 17 , 18. We also found secondary uses being used for financial and service planning, incident tracking, the teaching of clinical staff and billing 19 , 20…”

Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India

“…The remote automated laboratory system data published in 2009 and 2011 were a result of this centralized data collection. [ 19 ]…”