Advertisement

Current Diabetes Reports

, 17:70 | Cite as

Remote Monitoring and Consultation of Inpatient Populations with Diabetes

  • Robert J. RushakoffEmail author
  • Joshua A. Rushakoff
  • Zachary Kornberg
  • Heidemarie Windham MacMaster
  • Arti D. Shah
Health Care Delivery Systems and Implementation in Diabetes (ME McDonnell and AR Sadhu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Health Care Delivery Systems and Implementation in Diabetes

Abstract

Purpose of Review

Inpatient hyperglycemia is common and is linked to increased morbidity and mortality. We review current and innovative ways diabetes specialists consult in the management of inpatient diabetes.

Recent Findings

With electronic medical records (EMRs), remote monitoring and intervention may improve the management of inpatient hyperglycemia. Automated reports allow monitoring of glucose levels and allow diabetes teams to intervene through formal or remote consultation.

Summary

Following a 2-year transition of our complex paper-based insulin order sets to be EMR based, we leveraged this change by developing new daily glycemic reports and a virtual glucose management service (vGMS). Based on a daily report identifying patients with two or more glucoses over 225 mg/dl and/or a glucose <70 mg/dl in the past 24 h, a vGMS note with management recommendations was placed in the chart. Following the introduction of the vGMS, the proportion of hyperglycemic patients decreased 39% from a baseline of 6.5 per 100 patient-days to 4.0 per 100 patient-days The hypoglycemia proportion decreased by 36%. Ninety-nine percent of surveyed medical and surgical residents said the vGMS was both important and helpful.

Keywords

Hospital diabetes Inpatient diabetes Hospital insulin Inpatient insulin Virtual management 

Notes

Compliance with Ethical Standards

Conflict of Interest

Robert J. Rushakoff, Joshua A. Rushakoff, Zachary Kornberg, Heidemarie Windham MacMaster, and Arti D. Shah declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki Declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Meng Y-Y, Pickett M, Babey SH, Davis AC, Goldstein H. Diabetes tied to a third of California hospital stays, driving health care costs higher. http://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=1278. Accessed 27 Sept 2015.
  2. 2.
    Bersoux S, Cook CB, Kongable GL, Shu J, Zito DR. Benchmarking glycemic control in U.S. hospitals. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2014;20(9):876–83. doi: 10.4158/EP13516.OR.Google Scholar
  3. 3.
    Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978–82. doi: 10.1210/jcem.87.3.8341.CrossRefPubMedGoogle Scholar
  4. 4.
    Nanayakkara N, Nguyen H, Churilov L, et al. Inpatient HbA1c testing: a prospective observational study. BMJ Open Diabetes Res Care. 2015;3(1):e000113. doi: 10.1136/bmjdrc-2015-000113.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Falciglia M, Freyberg RW, Almenoff PL, D’Alessio DA, Render ML. Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med. 2009;37(12):3001–9.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Cheung NW, Napier B, Zaccaria C, Fletcher JP. Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition. Diabetes Care. 2005;28(10):2367–71.CrossRefPubMedGoogle Scholar
  7. 7.
    Zapatero A, Gómez-Huelgas R, González N, et al. Frequency of hypoglycemia and its impact on length of stay, mortality, and short-term readmission in patients with diabetes hospitalized in internal medicine wards. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2014;20(9):870–5. doi: 10.4158/EP14006.OR.Google Scholar
  8. 8.
    Brodovicz KG, Mehta V, Zhang Q, et al. Association between hypoglycemia and inpatient mortality and length of hospital stay in hospitalized, insulin-treated patients. Curr Med Res Opin. 2013;29(2):101–7. doi: 10.1185/03007995.2012.754744.CrossRefPubMedGoogle Scholar
  9. 9.
    Nirantharakumar K, Marshall T, Kennedy A, Narendran P, Hemming K, Coleman JJ. Hypoglycaemia is associated with increased length of stay and mortality in people with diabetes who are hospitalized. Diabet Med J Br Diabet Assoc. 2012;29(12):e445–8. doi: 10.1111/dme.12002.CrossRefGoogle Scholar
  10. 10.
    Donihi AC, Gibson JM, Noschese ML, et al. Effect of a targeted glycemic management program on provider response to inpatient hyperglycemia. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2011;17(4):552–7. doi: 10.4158/EP10330.OR.Google Scholar
  11. 11.
    Rajendran R, Round R-M, Kerry C, Barker S, Rayman G. Diabetes patient at risk score—a novel system for triaging appropriate referrals of inpatients with diabetes to the diabetes team. Clin Med Lond Engl. 2015;15(3):229–33. doi: 10.7861/clinmedicine.15-3-229.CrossRefGoogle Scholar
  12. 12.
    Lubitz CC, Seley JJ, Rivera C, Sinha N, Brillon DJ. The perils of inpatient hyperglycemia management: how we turned apathy into action. Diabetes Spectr. 2007;20(1):18–21.CrossRefGoogle Scholar
  13. 13.
    Seheult JN, Pazderska A, Gaffney P, et al. Addressing inpatient glycaemic control with an inpatient glucometry alert system. Int J Endocrinol Int J Endocrinol. 2015;2015:e807310. doi: 10.1155/2015/807310.Google Scholar
  14. 14.
    Apsey H, Coan K, Castro J, Jameson K, Schlinkert R, Cook C. Overcoming clinical inertia in the management of postoperative patients with diabetes. Endocr Pract. 2013;20(4):320–8. doi: 10.4158/EP13366.OR.CrossRefGoogle Scholar
  15. 15.
    Levetan CS, Salas JR, Wilets IF, Zumoff B. Impact of endocrine and diabetes team consultation on hospital length of stay for patients with diabetes. Am J Med. 1995;99(1):22–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Mularski KS, Yeh CP, Bains JK, Mosen DM, Hill AK, Mularski RA. Pharmacist glycemic control team improves quality of glycemic control in surgical patients with perioperative dysglycemia. Perm J. 2012;16(1):28–33.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Koproski J, Pretto Z, Poretsky L. Effects of an intervention by a diabetes team in hospitalized patients with diabetes. Diabetes Care. 1997;20(10):1553–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Flanagan D, Moore E, Baker S, Wright D, Lynch P. Diabetes care in hospital—the impact of a dedicated inpatient care team. Diabet Med J Br Diabet Assoc. 2008;25(2):147–51. doi: 10.1111/j.1464-5491.2007.02326.x.CrossRefGoogle Scholar
  19. 19.
    Wang YJ, Seggelke S, Hawkins RM, et al. Impact of glucose management team on outcomes of hospitalizaron in patients with type 2 diabetes admitted to the medical service. Endocr Pract. 2016;22(12):1401–5. doi: 10.4158/EP161414.OR.CrossRefPubMedGoogle Scholar
  20. 20.
    Baldwin D, Villanueva G, McNutt R, Bhatnagar S. Eliminating inpatient sliding-scale insulin: a reeducation project with medical house staff. Diabetes Care. 2005;28(5):1008–11.CrossRefPubMedGoogle Scholar
  21. 21.
    Rushakoff RJ, Sullivan MM, Seley JJ, et al. Using a mentoring approach to implement an inpatient glycemic control program in United States hospitals. Healthc Amst Neth. 2014;2(3):205–10. doi: 10.1016/j.hjdsi.2014.06.004.CrossRefGoogle Scholar
  22. 22.
    Sullivan MM, O’Brien CR, Gitelman SE, Shapiro SE, Rushakoff RJ. Impact of an interactive online nursing educational module on insulin errors in hospitalized pediatric patients. Diabetes Care. 2010;33(8):1744–6. doi: 10.2337/dc10-0031.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Weinberg ME, Bacchetti P, Rushakoff RJ. Frequently repeated glucose measurements overestimate the incidence of inpatient hypoglycemia and severe hyperglycemia. J Diabetes Sci Technol. 2010;4(3):577–82.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Maynard G, Schnipper JL, Messler J, et al. Design and implementation of a web-based reporting and benchmarking center for inpatient glucometrics. J Diabetes Sci Technol. 2014;8(4):630–40. doi: 10.1177/1932296814532237.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Thomas P, E Inzucchi S. An internet service supporting quality assessment of inpatient glycemic control. J Diabetes Sci Technol. 2008;2(3):402–408. doi: 10.1177/193229680800200309.
  26. 26.
    Rushakoff RJ, Woeber KA. Evaluation of a “formal” endocrinology curbside consultation service: advice by means of internet, fax, and telephone. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2003;9(2):124–7.Google Scholar
  27. 27.
    Rushakoff RJ, Rushakoff JA. Evolution of the curbside consult commentary on transforming the endocrine consult: asynchronous provider consultations. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2015;21(5):554–6. doi: 10.4158/EP15625.CO.Google Scholar
  28. 28.
    Cruz ML, Gleason N, Wang M, Wrenn K, Gonzales R. Transforming the endocrine consult: asynchronous provider consultations. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2015;21(5):514–21. doi: 10.4158/EP14297.OR.Google Scholar
  29. 29.
    Tran CS, Liddy CE, Liu DM, Afkham A, Keely EJ. Consults to endocrinologists improve access and change primary care provider behavior. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2016;22(10):1145–50. doi: 10.4158/E161321.OR.Google Scholar
  30. 30.
    Mendez CE, Ata A, Rourke JM, Stain SC, Umpierrez G. Daily inpatient glycemic survey (DINGS): a process to remotely identify and assist in the management of hospitalized patients with diabetes and hyperglycemia. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2015;21(8):927–35. doi: 10.4158/EP14577.OR.Google Scholar
  31. 31.
    Amor AJ, Ríos PA, Graupera I, et al. Management of inpatient glucose in non-critical care setting: impact of a proactive intervention based on a point-of-care of system with remote viewing of capillary blood glucose. Med Clínica. 2014;142(9):387–92. doi: 10.1016/j.medcli.2013.01.037.CrossRefGoogle Scholar
  32. 32.
    •• Rushakoff RJ, Sullivan MM, MacMaster HW, et al. Association between a virtual glucose management service and glycemic control in hospitalized adult patients: an observational study. Ann Intern Med. 2017;166(9):621–7. doi: 10.7326/M16-1413. This study describes the design, implementation and full results of the UCSF virtual glucose management service and the significant impact on decreasing both hyper- and hypoglycemia in hospitalized adult patients. CrossRefPubMedGoogle Scholar
  33. 33.
    • Neinstein A, MacMaster HW, Sullivan MM, Rushakoff R. A detailed description of the implementation of inpatient insulin orders with a commercial electronic health record system. J Diabetes Sci Technol. 2014;8(4):641–51. doi: 10.1177/1932296814536290. This study fully describes all the steps required to successfully implement insulin orders sets into an electronic medical record system. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Robert J. Rushakoff
    • 1
    Email author
  • Joshua A. Rushakoff
    • 2
  • Zachary Kornberg
    • 2
  • Heidemarie Windham MacMaster
    • 3
  • Arti D. Shah
    • 4
    • 5
  1. 1.Division of Endocrinology and MetabolismUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.School of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Departments of Pharmacy and NursingUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Division of Endocrinology and MetabolismUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.Division of Endocrinology and MetabolismUniversity of California, Los AngelesLos AngelesUSA

Personalised recommendations