title: Behavioral Modification of Intraoperative Hyperglycemia Management with a Novel Real-time Audiovisual Monitor.
abstract: BACKGROUND
  Hyperglycemia, defined as blood glucose (BG) levels above 200 mg/dl (11.1 mM), is associated with increased postoperative morbidity. Yet, the treatment standard for intraoperative glycemic control is poorly defined for noncardiac surgery. Little is known of the interindividual treatment variability or methods to modify intraoperative glycemic management behaviors. AlertWatch (AlertWatch, USA) is a novel audiovisual alert system that serves as a secondary patient monitor for use in operating rooms. The authors evaluated the influence of use of AlertWatch on intraoperative glycemic management behavior.
  
  
  METHODS
  AlertWatch displays historical patient data (risk factors and laboratory results) from multiple networked information systems, combined with the patient's live physiologic data. The authors extracted intraoperative data for 19 months to evaluate the relationship between AlertWatch usage and initiation of insulin treatment for hyperglycemia. Outcome associations were adjusted for physical status, case duration, procedural complexity, emergent procedure, fasting BG value, home insulin therapy, patient age, and primary anesthetist.
  
  
  RESULTS
  Overall, 2,341 patients had documented intraoperative hyperglycemia. Use of AlertWatch (791 of 2,341; 33.5%) was associated with 55% increase in insulin treatment (496 of 791 [62.7%] with and 817 of 1,550 [52.7%] without AlertWatch; adjusted odds ratio [95% CI], 1.55 [1.23 to 1.95]; P < 0.001) and 44% increase in BG recheck after insulin administration (407 of 791 [51.5%] with AlertWatch and 655 of 1,550 [42.3%] in controls; adjusted odds ratio [95% CI], 1.44 [1.14 to 1.81]; P = 0.002).
  
  
  CONCLUSIONS
  AlertWatch is associated with a significant increase in desirable intraoperative glycemic management behavior and may help achieve tighter intraoperative glycemic control.
authors.affiliation: From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Subramanian
authors.initials: S
authors.lastname: Sathishkumar
authors.forename: Manda
authors.initials: M
authors.lastname: Lai
authors.forename: Paul
authors.initials: P
authors.lastname: Picton
authors.forename: Sachin
authors.initials: S
authors.lastname: Kheterpal
authors.forename: Michelle
authors.initials: M
authors.lastname: Morris
authors.forename: Amy
authors.initials: A
authors.lastname: Shanks
authors.forename: Satya Krishna
authors.initials: SK
authors.lastname: Ramachandran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001296:Audiovisual Aids; D001521:Behavior Therapy / Q000295:instrumentation / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D003199:Computer Systems; D019468:Disease Management; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001786:Blood Glucose