Retrospective Quality Improvement Study of Insulin-Induced Hypoglycemia and Implementation of Hospital-Wide Initiatives

Abstract

Background: Hospitalized patients who are receiving antihyperglycemic agents are at increased risk for hypoglycemia. Inpatient hypoglycemia may lead to increased risk for morbidity, mortality, prolonged hospitalization, and readmission within 30 days of discharge, which in turn may lead to increased costs. Hospital-wide initiatives targeting hypoglycemia are known to be beneficial; however, their impact on patient care and economic measures in community nonteaching hospitals are unknown. Methods: This retrospective quality improvement study examined the effects of hospital-wide hypoglycemia initiatives on the rates of insulin-induced hypoglycemia in a community hospital setting from January 1, 2016, until September 30, 2019. The potential cost of care savings has been calculated. Results: Among 49 315 total patient days, 2682 days had an instance of hypoglycemia (5.4%). Mean ± SD hypoglycemic patient days/month was 59.6 ± 16.0. The frequency of hypoglycemia significantly decreased from 7.5% in January 2016 to 3.9% in September 2019 ( P = .001). Patients with type 2 diabetes demonstrated a significant decrease in the frequency of hypoglycemia (7.4%-3.8%; P < .0001), while among patients with type 1 diabetes the frequency trended downwards but did not reach statistical significance (18.5%-18.0%; P = 0.08). Based on the reduction of hypoglycemia rates, the hospital had an estimated cost of care savings of $98 635 during the study period. Conclusions: In a community hospital setting, implementation of hospital-wide initiatives targeting hypoglycemia resulted in a significant and sustainable decrease in the rate of insulin-induced hypoglycemia. These high-leverage risk reduction strategies may be translated into considerable cost savings and could be implemented at other community hospitals.

The Endocrine Hospitalist: Enhancing the Quality of Diabetes Care

“…Carter et al reported the frequency of hypoglycemia significantly decreased at Suburban Hospital from 7.5% in January 2016 to 3.9% in September 2019 (P = .001) with an estimated cost of care savings of $98 635. 35 After the expansion and replication of the program to Howard County General Hospital, another community hospital within the Johns Hopkins Health System, Demidowich and colleagues reported that hyperglycemia at this institution decreased among patients comanaged by endocrine hospitalists (53.8%-42.5%, P < .0001), though no change in length of stay or readmission was noted. 32 The authors speculated that other issues such as barriers to care, medical literacy, and/or lack of health insurance may have contributed to a lack of reduction in the length of stay in that study.…”

“…Briefly, this is an interdisciplinary team consisting of an endocrinologist, pharmacist, nurse educators, transition guide nurses, community health and wellness nurses, dietitian, information technology specialist, patient and family advisor, and quality improvement representative. 1,35 The committee developed and implemented hospitalwide glucose policies and initiatives, providing targeted education and support to facilitate policy acceptance. 1,29,31,[34][35][36] While the Endocrine Hospitalist program was heavily focused on diabetes (Figure 2), I also took the time to develop a relationship with cardiothoracic surgeons, neurosurgeons, and ear, nose, throat (ENT) specialists.…”

“…1,35 The committee developed and implemented hospitalwide glucose policies and initiatives, providing targeted education and support to facilitate policy acceptance. 1,29,31,[34][35][36] While the Endocrine Hospitalist program was heavily focused on diabetes (Figure 2), I also took the time to develop a relationship with cardiothoracic surgeons, neurosurgeons, and ear, nose, throat (ENT) specialists. Additionally, I I used to wake up early in order to be at the hospital by 6:45 am to join the "nursing change of shift report" and educate nurses on the evidence-based hypoglycemia protocol, 35 how to use an insulin pen, the purpose of basal-bolus insulin therapy, 36 and dynamic endocrine tests.…”

Hospital Diabetes Meeting 2022

“…In collaboration with pharmacists, nurses, dieticians, diabetes care and education specialists, and advanced practice providers, the endocrine hospitalist can enhance the quality of inpatient diabetes care by reducing rates of both hyperglycemia and hypoglycemia, decreasing length of stay, and reducing readmissions. [55][56][57] A comparison of length of stay between a cohort of patients cared for by an IDMS team and a non-IDMS group is presented in Figure 9. These outcomes are achieved through quality improvement initiatives, development and implementation of hospital policies, discharge planning, nursing and medical staff education, collaboration with other subspecialties, and direct patient care (diabetes and endocrine consultations).…”

“…57 Reduction in hypoglycemia rates achieved through quality work overseen by an endocrine hospitalist was associated with annual cost savings of $100,000. 56,59 Endocrine hospitalists can play an important leadership role in reviewing internal glucometric data, benchmarking against other hospitals, and oversight of reportable glycemic metrics. 54,55,60 Endocrine hospitalists improve clinical outcomes and secure a return on investment for hospitals.…”