Intensive Care Medicine

, Volume 37, Issue 7, pp 1151–1157

Impact of a computer-generated alert system on the quality of tight glycemic control

  • Geert Meyfroidt
  • Pieter Wouters
  • Wilfried De Becker
  • Dominiek Cottem
  • Greet Van den Berghe
Original

DOI: 10.1007/s00134-011-2159-7

Cite this article as:
Meyfroidt, G., Wouters, P., De Becker, W. et al. Intensive Care Med (2011) 37: 1151. doi:10.1007/s00134-011-2159-7

Abstract

Purpose

To assess the impact of a computer-generated blood glucose (BG) alert, generated by a Patient Data Management System (PDMS) and superimposed on a paper-based guideline, on tight glycemic control (TGC) in the intensive care unit (ICU).

Methods

TGC in the Leuven University Hospitals is performed by nurses using a paper-based guideline that allows anticipative, intuitive decision-making. An electronic alert was implemented on 1 August 2007 in which a pop-up appears in the PDMS at the following BG thresholds: >180, >110, 60–80, 40–60 and <40 mg/dl. The impact of this electronic alert was assessed by a sequential cohort study: the mean BG, the glycemic penalty index (GPI), the hyperglycemic index (HGI), the number of hypoglycemic events, the standard deviation (SD) of the BG time series and the number of BG measurements were compared in all adults admitted 6 months before (‘pre-alert group’, n = 729) and after (‘alert group’, n = 644) the implementation of the electronic alert.

Results

The alert resulted in a reduction of mean BG (112 vs. 110 mg/dl, p = 0.002), GPI (20 vs. 19, p = 0.029) and HGI (10 vs. 9 mg/dl, p = 0.004), without increasing BG sampling (median 25 measurements/patient in both groups, p = 0.776). The alert reduced the proportion of patients experiencing an episode of hypoglycemia from 6.5 to 4.0% (p = 0.043). The SD of the BG time series was not affected (28 mg/dl in both groups, p = 0.566).

Conclusion

A computer-generated alert was able to statistically significantly improve the quality of TGC in ICU patients without increasing the need for blood sampling.

Keywords

Intensive care Critical illness Blood glucose Hypoglycemia Computer assisted drug therapy Insulin infusion system 

Supplementary material

134_2011_2159_MOESM1_ESM.doc (32 kb)
Supplementary Appendix 1 (DOC 33 kb)
134_2011_2159_MOESM2_ESM.doc (26 kb)
Supplementary Appendix 2 (DOC 27 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Geert Meyfroidt
    • 1
  • Pieter Wouters
    • 1
  • Wilfried De Becker
    • 1
  • Dominiek Cottem
    • 1
  • Greet Van den Berghe
    • 1
  1. 1.Department of Intensive Care MedicineKatholieke Universiteit LeuvenLeuvenBelgium

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