title: Practice changes in glycemic management and outcomes in coronary artery bypass surgery patients.
abstract: This study aims to evaluate whether a quality improvement initiative in hyperglycemia management could result in substantiated practice changes and improved outcomes for coronary artery bypass surgery patients. Retrospective chart review and analysis of 103 randomly selected patients hospitalized for coronary artery bypass surgery was used. After the glycemia awareness initiative, the perioperative use of intravenous insulin infusion therapy increased in the total population (P = .01) as well as in the diabetes population (P = .03). Frequency of blood glucose level tests ordered for nondiabetic patients increased from 2.8 per day to 4.3 per day (P = .38). Blood glucose values improved in the diabetic population (Ps = .02, .048). The average length of stay improved in all nondiabetic patients (10.7-8.1 days, P = .07) including those who had coronary artery bypass graft surgery with cardiac catheterization (7.8-6.2 days, P = .09) and coronary artery bypass graft surgery with catheterization with complications (15.0-9.0 days, P = .12). The glycemia awareness initiative resulted in a positive impact on practice patterns. Undiagnosed diabetes and impaired fasting glucose are important and unrecognized issues within this hospital population. It is recommended that healthcare practitioners assume that cardiac patients have an increased likelihood of impaired fasting glucose and hyperglycemia. Advanced practice nurses can improve patient outcomes by ordering glucose testing and glycemic management as a routine practice for all cardiac surgery patients, regardless of diabetes diagnosis. Cardiac staff nurses can recommend glucose testing and screening for prediabetes and diabetes as a routine part of all nursing assessment.
authors.affiliation: American Healthways, Nashville, Tenn. 37215, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Pennell
authors.forename: Cecilia M
authors.initials: CM
authors.lastname: Smith-Snyder
authors.forename: Laurel R
authors.initials: LR
authors.lastname: Hudson
authors.forename: G Brent
authors.initials: GB
authors.lastname: Hamar
authors.forename: Joanne
authors.initials: J
authors.lastname: Westerfield
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D015190:Blood Glucose Self-Monitoring / Q000592:standards; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration*; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care / Q000451:nursing / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D012189:Retrospective Studies; D017749:Total Quality Management / Q000458:organization & administration*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin