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Management of raised glucose, a clinical decision tool to reduce length of stay of patients with hyperglycaemia
Author(s) -
Herring R.,
RussellJones D. L.,
Pengilley C.,
Hopkins H.,
Tuthill B.,
Wright J.,
Hordern S. V.,
Pengilley C.,
Hopkins H.,
Tuthill B.,
Davidson S.
Publication year - 2013
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12006
Subject(s) - medicine , diabetes mellitus , clinical practice , attendance , patient satisfaction , clinical decision support system , diabetes management , insulin , emergency medicine , intensive care medicine , physical therapy , surgery , type 2 diabetes , decision support system , endocrinology , artificial intelligence , computer science , economics , economic growth
Diabet. Med. 30, 81–87 (2013) Abstract Objective To assess whether the introduction of a management of raised glucose clinical decision tool could improve assessment of patients with hyperglycaemia by non‐specialist physicians, leading to early discharge and improved quality of inpatient care. Methods Participants were adults aged 18 years or over presenting to the Medical Assessment Unit with a capillary blood glucose level > 11.1 mmol/l. Phase 1 of the study (phase 1) evaluated current clinical practice and potential impact of the clinical decision tool. Phase 2 evaluated the effectiveness of the management of raised glucose tool in clinical practice. Primary outcome measures were inpatient length of stay and same‐calendar‐day discharges. Secondary outcome measures were diabetes specialist input, patient assessment, intravenous insulin infusion use and patient satisfaction. Results Implementation of the management of raised glucose clinical decision tool allowed safe, same‐calendar‐day discharges of 40% of patients with hyperglycaemia as their primary reason for attendance. Median length of stay was lower in the phase 1 than in phase 2 (1.0 vs. 3.5 days, P < 0.01). Early discharge did not result in an increase in readmissions. There was improvement in hyperglycaemia assessment for all patients ( P < 0.01), a reduction in the use of intravenous insulin infusions ( P < 0.01) and high level of patient satisfaction. Conclusion The management of raised glucose clinical decision tool resulted in a significant increase in the number of same‐calendar‐day discharges and reduction in hospital length of stay without adverse impact on readmission rates. Additionally, the tool was associated with improvements in inpatient diabetes care and patient satisfaction.