Effectively identifying the inpatient with hyperglycemia to increase patient care and lower costs.
Recent years have seen an increased focus on merging quality care and financial results. This focus not only extends to the inpatient setting but also is of major importance in assuring effective transitions of care from hospital to home. Inducements to meld the 2 factors include tying payment to quality standards, investing in patient safety, and offering new incentives for providers who deliver high-quality and coordinated care. Once seen as the purview of primary care or specific surgical screening programs, identification of patients with hyperglycemia or undiagnosed diabetes mellitus now presents providers with opportunities to improve care. Part of the new focus will need to address the length of stay for patients with diabetes mellitus. These patients are proven to require longer hospital stays regardless of the admission diagnosis. With reducing length of stay as a major objective, efficiency combined with improved quality is the desired outcome. Even with the mounting evidence supporting the benefits of improving glycemic control in the hospital setting, institutions continue to struggle with inpatient glycemic control. Multiple national groups have provided recommendations for blood glucose assessment and glycated hemoglobin testing. This article identifies the key benefits in identifying patients with hyperglycemia and reviews possible ways to identify, monitor, and treat this potential problem area and thereby increase the level of patient care and cost-effectiveness.
Assistant Professor, Duke University School of Nursing; Division of Endocrinology, Duke University School of Medicine, Durham, NC. melanie.mabrey@duke.edu.
Melanie E
ME
Mabrey
Raymie
R
McFarland
Sandra L
SL
Young
Penny L
PL
Cooper
Paul
P
Chidester
Andrew S
AS
Rhinehart
D001786:Blood Glucose; D003266:Continuity of Patient Care / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D006442:Glycated Hemoglobin; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007902:Length of Stay / Q000706:statistics & numerical data; D008403:Mass Screening / Q000458:organization & administration; D009026:Mortality; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000458:organization & administration*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin