Inadequate glucose control can result in hospital-associated infections and other complications that can lead to increased lengths of stay and nonreimbursable readmissions within 30 days. By using Six Sigma methodologies to redesign processes, educating physicians, staff and patients, and embedding evidence-based protocols in our computerized physician-order entry system, Decatur (Ill.) Memorial Hospital has made proactive management of inpatient diabetes the rule rather than the exception.
For at least 60 years, the use of a sliding scale to reactively manage insulin has been passed down by physicians from one generation to the next. It prescribes the amount of insulin based on the glucose reading—a reactive approach that can result in glycemic swings. Current best practice points to anticipatory physiologic insulin dosing, prescribed as a basal/nutritional/correctional regimen. Before launching our glucose control initiative, a year's worth of data showed that 55% of Decatur's inpatients were being managed solely using sliding scale and only 72% of patients maintained glucose readings below 180 throughout their stay.