Optimizing Diabetes Management: Glycemic Control for Inpatient Care

When a diabetic patient enters a hospital, their fluctuations in blood sugar levels can lead to significant complications. Not only can blood sugar spikes cause harm to a patient’s kidneys, eyes, nerves and skin, they can slow recovery from surgical procedures.

After identifying hyperglycemia events occurring at a rate of 38.36 per 100 patient days early in 2018, Greater Baltimore Medical Center (GBMC) established a multi-disciplinary diabetes steering committee to design a standardized, evidence-based, diabetes management workflow for clinicians and dietary team members.

Glycemic Control for Inpatient Care

GBMC developed a clinical workflow to enhance their diabetic patients’ disease management—building around a comprehensive diabetes mellitus/hyperglycemia management order set containing basal, mealtime and sliding scale insulin orders, and insulin orders when withholding patients’ food and fluids.

The adoption of banners in the EHR visual interface and a variety of alerts within the structured workflow of both clinical staff and dietary staff has improved timing of finger stick performance; made insulin pumps orderable within the medication administration record; and improved collaboration between dietary and nursing to ensure on-time meal delivery and insulin administration. When a diabetes diagnosis is entered into a patient’s problem list, diabetes-specific care plans and patient education are uploaded automatically. This automation updates the decision support and template workflow of the clinicians and dietary staff, while educating patients about how they can more effectively manage their own health and wellness.

Throughout the process, GBMC reinforced adherence to diabetes management standards of care through accountability for diabetic events. The GBMC executive management team declared the reduction of diabetic events per 100 patient days as a core executive lean daily management metric within the hospital. Physicians and nurses are tracked on both compliance with the diabetes management care plan and its impact on the number of diabetic events, made visual in Tableau reports.

Since adopting these new technology-enabled practices to improve adherence to the diabetes care plan, GBMC observed some remarkable results: patients with moderate to severe hyperglycemia and hypoglycemia events decreased per 100 days from 38.36 events to 26.16 events, and patients admitted with diabetic ketoacidosis saw a significant decrease in mortality and readmission rates.  

Davies Award Success Story

HIMSS is pleased to recognize GBMC as one of only six healthcare organizations in North America to receive a second Davies Award. “Greater Baltimore Medical Center has made a firm commitment to introspective, data-driven review of their care processes to identify ways they can innovate their care delivery,” said Jonathan French, senior director of thought advisory and the Davies Award of Excellence program at HIMSS. “They recognized the need for improved coordination between dietary and clinical team members and leveraged technology as a mechanism to bridge the gap. Accountability for the standard of care being met drives improved patient outcomes.”

“Diabetes management is a multi-disciplinary problem, involving knowledge and coordination between multiple departments to achieve the best outcomes,” said Malcom Tucker, MD, chief medical officer at Greater Baltimore Medical Center. “Greater Baltimore Medical Center is honored to receive the 2020 HIMSS Davies Award and takes great pride in leveraging data to drive collaborative adoption of care improvement strategies to improve the outcomes for our patients.”