This study will assess the implementation of a glucose management clinical decision support tool. The specific objective is to determine if supplementing the existing glucose check reminder with a best practice advisory (BPA), an actionable insulin dosing calculator, providers will be influenced to improve the control of hyperglycemia.
Poor intraoperative glucose control has been linked to multiple types of infections including surgical site infections and urinary tract infections. Several studies suggest maintaining glucose at less than 180 mg/dL effectively prevents infections, and minimizes risks of hypoglycemia as compared to stricter blood glucose targets. The insulin dosing protocol that will be used in the study is available for use throughout the Vanderbilt University Medical Center (VUMC) Department of Anesthesiology. The insulin calculator (BPA) automates the protocol guidelines. When a patient meets the study criteria, the BPA will provide an automated notification through the electronic health record system. These automated notifications will pop up intraoperatively after the glucose check reminder in cases where the patient meets the study criteria. The provider is not forced to follow the recommendations of the insulin dosing calculator, rather it just serves as a reminder of best practices as defined by our department. The specific objective is to determine if supplementing the existing glucose check reminder with a BPA, an actionable insulin dosing calculator, will influence providers to improve the control of hyperglycemia. Study results will guide the future integration of the BPA at VUMC.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
7,232
The BPA intervention will test the delivery of the insulin calculator (BPA) which automates the standard insulin dosing protocol guidelines through the electronic health record system.
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Hyperglycemia (glucose >180 mmol/dL)
Frequency of hyperglycemia (glucose \>180 mg/dL) at first Post Anesthesia Care Unit (PACU) measurement.
Time frame: PACU admission to discharge (1-3 hours post operatively)
Hypoglycemia (glucose <60 mmol/dL)
Frequency of hypoglycemia (glucose \<60 mmol/dL) at first PACU measurement
Time frame: PACU admission to discharge (1-3 hours post operatively)
Intraoperative glucose monitoring
Frequency of intraoperative glucose monitoring
Time frame: Intraoperative
Adherence to Multicenter Perioperative Outcomes Group (MPOG) GLU-01
MPOG GLU-01 is a quality measure defined as the percentage of cases with perioperative glucose \>200 mg/DL with \>200 mg/dL with administration of insulin or glucose recheck within 90 minutes of original glucose measurement.
Time frame: Intraoperative
Adherence to MPOG GLU-05
Percentage of cases with administration of insulin within 90 minutes of blood glucose \>200 mg/dL.
Time frame: Intraoperative
Intraoperative Insulin
Total administered intraoperative insulin (Units)
Time frame: Intraoperative
Magnitude of intraoperative hyperglycemia
Magnitude of intraoperative hyperglycemia defined as the product of time and glucose level when glucose is greater than 180 mmol/dL (the area outside of normoglycemia)
Time frame: Intraoperative
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Glucose at first PACU measurement
Glucose at first PACU measurement
Time frame: PACU admission to discharge (1-3 hours post operatively)