Inpatient Diabetes Management During the COVID-19 Crisis: Experiences From Two Community Hospitals

Shelton, Carter; Demidowich, Andrew P.; Zilbermint, Mihail

doi:10.1177/1932296820930268

Cited by 12 publications

(12 citation statements)

References 10 publications

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“…9,24,25 Moreover, during the COVID-19 pandemic, IDMS has been shown to positively impact the care of patients with diabetes in the community hospital setting. 26 Therefore, it is somewhat surprising that in this study reductions in hyper-and hypoglycemia were not associated with improvements in hospital-related metrics such as LOS and 30DRR. Good inpatient glycemic control has been previously associated with reduced LOS and 30DRR, 27 while in-hospital hypoglycemia has been correlated with increased LOS, 30DRR, and 30-day mortality.…”

Section: Discussionmentioning

confidence: 62%

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Effects of a Dedicated Inpatient Diabetes Management Service on Glycemic Control in a Community Hospital Setting

Demidowich

Batty

Love

et al. 2021

J Diabetes Sci Technol

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Background: Community hospitals account for over 84% of all hospitals and over 94% of hospital admissions in the United States. In academic settings, implementation of an Inpatient Diabetes Management Service (IDMS) model of care has been shown to reduce rates of hyper- and hypoglycemia, hospital length of stay (LOS), and associated hospital costs. However, few studies to date have evaluated the implementation of a dedicated IDMS in a community hospital setting. Methods: This retrospective study examined the effects of changing the model of inpatient diabetes consultations from a local, private endocrine practice to a full-time endocrine hospitalist on glycemic control, LOS, and 30-day readmission rates in a 267-bed community hospital. Results: Overall diabetes patient days for the hospital were similar pre- and post-intervention (20,191 vs 20,262); however, the volume of patients seen by IDMS increased significantly after changing models. Rates of hyperglycemia decreased both among patients seen by IDMS (53.8% to 42.5%, P < .0001) and those not consulted on by IDMS (33.2% to 29.9%; P < .0001). When examined over time, rates of hypoglycemia steadily decreased in the 24 months after dedicated IDMS initiation ( P = .02); no such time effect was seen prior to IDMS ( P = .34). LOS and 30DRR were not significantly different between IDMS models. Conclusions: Implementation of an endocrine hospitalist-based IDMS at a community hospital was associated with significantly decreased hyperglycemia, while avoiding concurrent increases in hypoglycemia. Further studies are needed to investigate whether these effects are associated with improvements in clinical outcomes, patient or staff satisfaction scores, or total cost of care.

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Section: Discussionmentioning

confidence: 62%

“…9,24,25 Moreover, during the COVID-19 pandemic, IDMS has been shown to positively impact the care of patients with diabetes in the community hospital setting. 26…”

Section: Discussionmentioning

confidence: 99%

Effects of a Dedicated Inpatient Diabetes Management Service on Glycemic Control in a Community Hospital Setting

Demidowich

Batty

Love

et al. 2021

J Diabetes Sci Technol

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“…Infection control teams may place a priority on conserving personal protective equipment and reducing the number of provider-patient interactions to minimize the spread of disease within the hospital. Inpatient diabetes telehealth services during the COVID-19 crisis has been successfully implemented across the Johns Hopkins Health System, which allows the hospitals to preserve personal protective equipment and limit physical exposure between patient and provider while increasing access to specialized diabetes care [57]. As noted above, IDMS programs may offer cost savings and can still be deployed efficiently by providing synchronous telehealth visits or asynchronous data review even during the pandemic.…”

Section: Idms and The Covid-19 Pandemicmentioning

confidence: 99%

The Financial Impact of an Inpatient Diabetes Management Service

et al. 2021

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Context Diabetes is a leading metabolic disorder with a substantial cost burden, especially in inpatient settings. The complexity of inpatient glycemic management has led to the emergence of inpatient diabetes management service (IDMS), a multidisciplinary team approach to glycemic management. Objective To review recent literature on the financial and clinical impact of IDMS in hospital settings. Methods We searched PubMed using a combination of controlled vocabulary and keyword terms to describe the concept of IDMS and combined the search terms with a comparative effectiveness filter for costs and cost analysis developed by the National Library of Medicine. Findings In addition to several improved clinical endpoints such as glycemic management outcomes, IDMS implementation is associated with hospital cost savings through decreased length of stay, preventing hospital readmissions, hypoglycemia reduction, and optimizing resource allocation. There are other downstream potential cost savings in long-term patient health outcomes and avoidance of litigation related to suboptimal glycemic management. Conclusion IDMS may play an important role in helping both academic and community hospitals to improve the quality of diabetes care and reduce costs. Clinicians and policymakers can utilize existing literature to build a compelling business case for IDMS to hospital administrations and state legislatures in the era of value-based healthcare.

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“…Of note, in 2015, Suburban Hospital implemented an inpatient diabetes management service led by an Endocrine Hospitalist team, a multidisciplinary coordinated effort to manage glycemia of patients with diabetes, as previously desc ribed. [19][20][21][22][23][24]…”

Section: Settingmentioning

confidence: 99%

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

Najmi¹,

Haque

Ansari

et al. 2021

J Diabetes Sci Technol

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Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

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Inpatient Diabetes Management During the COVID-19 Crisis: Experiences From Two Community Hospitals

Cited by 12 publications

References 10 publications

Effects of a Dedicated Inpatient Diabetes Management Service on Glycemic Control in a Community Hospital Setting

Effects of a Dedicated Inpatient Diabetes Management Service on Glycemic Control in a Community Hospital Setting

The Financial Impact of an Inpatient Diabetes Management Service

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

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