title: Decision Support Tool to Improve Glucose Control Compliance After Cardiac Surgery.
abstract: Hyperglycemia control is associated with improved outcomes in patients undergoing cardiac surgery. The Surgical Care Improvement Project metric (SCIP-inf-4) was introduced as a performance measure in surgical patients and included hyperglycemia control. Compliance with the SCIP-inf-4 metric remains suboptimal. A novel real-time decision support tool (DST) with guaranteed feedback that is based on the existing electronic medical record system was developed at a tertiary academic center. Implementation of the DST increased the compliance rate with the SCIP-inf-4 from 87.3% to 96.5%. Changes in tested clinical outcomes were not observed with improved metric compliance. This new framework can serve as a backbone for development of quality control processes for other metrics. Further and, ideally, multicenter studies are required to test if implementation of electronic DSTs will translate into improved resource utilization and outcomes for patients.
authors.affiliation: Vitali Fedosov is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Mikhail Dziadzko is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Joseph A. Dearani is Professor of Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota. Daniel R. Brown is Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Brian W. Pickering is Assistant Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Vitaly Herasevich is Associate Professor of Anesthesiology and Medicine, Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905 (herasevich.vitaly@mayo.edu).
authors.forename: Vitali
authors.initials: V
authors.lastname: Fedosov
authors.affiliation: Vitali Fedosov is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Mikhail Dziadzko is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Joseph A. Dearani is Professor of Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota. Daniel R. Brown is Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Brian W. Pickering is Assistant Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Vitaly Herasevich is Associate Professor of Anesthesiology and Medicine, Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905 (herasevich.vitaly@mayo.edu).
authors.forename: Mikhail
authors.initials: M
authors.lastname: Dziadzko
authors.affiliation: Vitali Fedosov is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Mikhail Dziadzko is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Joseph A. Dearani is Professor of Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota. Daniel R. Brown is Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Brian W. Pickering is Assistant Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Vitaly Herasevich is Associate Professor of Anesthesiology and Medicine, Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905 (herasevich.vitaly@mayo.edu).
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Vitali Fedosov is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Mikhail Dziadzko is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Joseph A. Dearani is Professor of Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota. Daniel R. Brown is Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Brian W. Pickering is Assistant Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Vitaly Herasevich is Associate Professor of Anesthesiology and Medicine, Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905 (herasevich.vitaly@mayo.edu).
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Brown
authors.affiliation: Vitali Fedosov is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Mikhail Dziadzko is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Joseph A. Dearani is Professor of Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota. Daniel R. Brown is Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Brian W. Pickering is Assistant Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Vitaly Herasevich is Associate Professor of Anesthesiology and Medicine, Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905 (herasevich.vitaly@mayo.edu).
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pickering
authors.affiliation: Vitali Fedosov is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Mikhail Dziadzko is Research Fellow, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Joseph A. Dearani is Professor of Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota. Daniel R. Brown is Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Brian W. Pickering is Assistant Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Vitaly Herasevich is Associate Professor of Anesthesiology and Medicine, Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905 (herasevich.vitaly@mayo.edu).
authors.forename: Vitaly
authors.initials: V
authors.lastname: Herasevich
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D006348:Cardiac Surgical Procedures / Q000592:standards*; D016022:Case-Control Studies; D064648:Critical Care Nursing / Q000379:methods*; D003658:Decision Making, Computer-Assisted; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose
keywords: alert; computer applications; outcomes; sepsis