title: Impact of a hypoglycemia reduction bundle and a systems approach to inpatient glycemic management.
abstract: OBJECTIVE
  Uncontrolled hyperglycemia and iatrogenic hypoglycemia represent common and frequently preventable quality and safety issues. We sought to demonstrate the effectiveness of a hypoglycemia reduction bundle, proactive surveillance of glycemic outliers, and an interdisciplinary data-driven approach to glycemic management.
  
  
  METHODS
  
  
  
  METHODS
  all hospitalized adult non-intensive care unit (non-ICU) patients with hyperglycemia and/or a diagnosis of diabetes admitted to our 550-bed academic center across 5 calendar years (CYs).
  
  
  METHODS
  hypoglycemia reduction bundle targeting most common remediable contributors to iatrogenic hypoglycemia; clinical decision support in standardized order sets and glucose management pages; measure-vention (daily measurement of glycemic outliers with concurrent intervention by the inpatient diabetes team); educational programs.
  
  
  METHODS
  Pearson chi-square value with relative risks (RRs) and 95% confidence intervals (CIs) were calculated to compare glycemic control, hypoglycemia, and hypoglycemia management parameters across the baseline time period (TP1, CY 2009-2010), transitional (TP2, CY 2011-2012), and mature postintervention phase (TP3, CY 2013). Hypoglycemia defined as blood glucose <70 mg/dL, severe hypoglycemia as <40 mg/dL, and severe hyperglycemia >299 mg/dL.
  
  
  RESULTS
  A total of 22,990 non-ICU patients, representing 94,900 patient-days of observation were included over the 5-year study. The RR TP3:TP1 for glycemic excursions was reduced significantly: hypoglycemic stay, 0.71 (95% CI, 0.65 to 0.79); severe hypoglycemic stay, 0.44 (95% CI, 0.34 to 0.58); recurrent hypoglycemic day during stay, 0.78 (95% CI, 0.64 to 0.94); severe hypoglycemic day, 0.48 (95% CI, 0.37 to 0.62); severe hyperglycemic day (>299 mg/dL), 0.76 (95% CI, 0.73 to 0.80).
  
  
  CONCLUSIONS
  Hyperglycemia and hypoglycemia event rates were both improved, with the most marked effect on severe hypoglycemic events. Most of these interventions should be portable to other hospitals.
authors.forename: Greg
authors.initials: G
authors.lastname: Maynard
authors.forename: Kristen
authors.initials: K
authors.lastname: Kulasa
authors.forename: Pedro
authors.initials: P
authors.lastname: Ramos
authors.forename: Diana
authors.initials: D
authors.lastname: Childers
authors.forename: Brian
authors.initials: B
authors.lastname: Clay
authors.forename: Meghan
authors.initials: M
authors.lastname: Sebasky
authors.forename: Ed
authors.initials: E
authors.lastname: Fink
authors.forename: Aaron
authors.initials: A
authors.lastname: Field
authors.forename: Marian
authors.initials: M
authors.lastname: Renvall
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Juang
authors.forename: Charles
authors.initials: C
authors.lastname: Choe
authors.forename: Diane
authors.initials: D
authors.lastname: Pearson
authors.forename: Brittany
authors.initials: B
authors.lastname: Serences
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lohnes
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000628:therapy*; D007003:Hypoglycemia / Q000517:prevention & control*; D007297:Inpatients; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose