title: Successful implementation of a perioperative glycemic control protocol in cardiac surgery: barrier analysis and intervention using lean six sigma.
abstract: Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 4-44, Boston, MA 02114, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Martinez
authors.forename: Raul
authors.initials: R
authors.lastname: Chavez-Valdez
authors.forename: Natalie F
authors.initials: NF
authors.lastname: Holt
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Grogan
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Khalifeh
authors.forename: Tammy
authors.initials: T
authors.lastname: Slater
authors.forename: Laura E
authors.initials: LE
authors.lastname: Winner
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moyer
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Lehmann
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