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Blood Glucose Benchmarking Results in

U.S. Hospital ICUs for 2008 Announced

Crozer-Chester Keystone Medical Center (PA), Central DuPage Hospital (IL), and Clarian Arnett Hospital (IN) are Top Performers in Program that Included Over 300 Participating Hospitals and 29.8 Million Test Results

CHARLOTTESVILLE VA - Medical Automation Systems has announced the benchmarking results from 2008 RALS Report, the largest data repository for hospital blood glucose measurement in the country. The 2008 results represent over 300 participating hospitals and 29.8 million glucose test results. Of those tests, approximately 7,700,000 were from the Intensive Care Unit (ICU).

The vast majority of the 5,000,000 patients admitted to the ICU each year have hyperglycemia—which is defined by the American Diabetes Association as generally >140mg/dL but should be kept as close to 110 mg/dL as possible.¹ Hyperglycemia may be due to the severity of their illness, a physiologic response to stress or undiagnosed diabetes mellitus. Effective control of ICU hyperglycemia has been shown to improve clinical outcomes by reducing hospital-acquired infection and other complications such as myocardial infarction, ischemic stroke and sepsis.²

Crozer-Chester Keystone ICUs Earn Top Spot with Mean Glucose of 121.6 mg/dL

The Intensive Care Units at Crozer-Chester Keystone Medical Center, Philadelphia, PA earned the top spot from over 300 reporting hospitals with a mean glucose of 121.6 mg/dL. According to Eileen Young, Director of Clinical Utilization and Outcomes at Crozer, “We have been working very hard at each site on glycemic control in our ICU’s so we hoped that our results would be great again this year.  We find the RALS Report interesting because we currently only have internal data.  Without outside benchmarks, you really do not know if your goal or expectations are appropriate.  When I can present feedback from the RALS Report relative to the performance of other institutions, the team sees that others can do it, so they can too.  This helps to keep them focused and to not give up.”

“Without outside benchmarks,  you really do not know if your

goals or expectations are appropriate.”

 Eileen Young, Director of Clinical Utilization and Outcomes, Crozer-Chester Keystone Medical Center

Dr. Riad Cachecho, the Director of Trauma and Shock Trauma Unit, stated that glycemic control at Crozer did not start overnight. “The project started when the Trauma Service expressed concerns about blood glucose control in the critical care areas at Crozer”, said Dr. Cacheco. “With the invaluable leadership and cooperation of the Pharmacy, Director of Endocrinology and the Nursing leadership they piloted the program at the Shock Trauma Unit and after demonstrating its success, disseminated it throughout the system.  It then became part of the VHA TICU collaborative, with an initial target of 150 mg/dL that later became 120 mg/dL. Crozer attributes their success to a multidisciplinary team and focused monthly ICU meetings. They also embrace collaborative education and coordination among nursing, intensivists, clinical pharmacists, endocrinologists and physician leaders”, he added.

Central DuPage Hosptial (IL) Improves Mean Blood Glucose Level Over 19%

Central DuPage Hosptial in Winfield, IL has improved their mean blood glucose level over 19% in their ICU from 2006 to 2008, resulting in a second place finish for 2008 with an ICU mean of 126.4 mg/dL.   As reported by Anne Drolet APN, Central DuPage Physician Group, “We use a multidisciplinary team approach to perform rounds everyday.  This includes, nurses, physicians, and pharmacists that all work with an end glucose goal of 85-115 mg/dL in mind.”

“ (our) nurses, physicians, and pharmacists (that) all work with

an end glucose goal of 85-115 mg/dL in mind.”

 Anne Drolet APN, Central DuPage Physician Group

Anne went on to say that the decisions made at Central DuPage to change  order sets, as well as other improvements have been the result of  input from many physicians and nurses. When asked about concern over hypoglyemic events, Toni Beymer, ICU Manager, stated that all the caregivers in the ICU know the evidence about hypoglycemia.  The data  show a lower rate of  hypoglycemia, making them comfortable with their current ICU glucose goals. As for doing so well compared to other hospitals, Dr. Cooke, the VP for Quality and Safety stated, “We are thrilled at the progress we have made over the past three years. We want to continue to do well.  We understand that our goals are somewhat of a moving target because the best glucose mean may be different for different types of patients within our ICU.” 

Clarian Arnett Credits Automated Insulin Dosing as One of their Keys to Success

Dr. Shannon Oates, chief Endocrinologist at Clarian Arnett Hospital in Indiana, (ICU glucose of 126.5, 3^rd place finisher) stated that their low mean glucose success stemmed from having the GlucoStabilizer insulin infusion program.

“The GlucoStabilizer allowing nurses to have more time to provide care at the patient bedside, and reduces potentially dangerous dosing calculation error.”
Dr. Shannon Oates, Chief Endocrinologist, Clarian Arnett Hospital

Dr Oates stated that, “The GlucoStabilizer technology computerizes the complex calculations used to determine the proper IV insulin dosage, improves a patient glucose control, saves critical staff time and resources by doing the calculations, thus allowing nurses to have more time to provide care at the patient bedside, and reduces potentially dangerous dosing calculation errors. The benefit to having IV insulin infusion is a decrease in the time required to achieve and maintain blood glucose targets. It takes significantly less time to get a patient out of the glucose danger zone and into the target zone, resulting in marked improvements in patient outcomes.  We also have targeted 50% dextrose doses for hypoglycemia that bring patients directly to the goal blood sugar.  In addition, we worked with our partners in food services and our menu indicates the carbohydrate grams for each item.”

References

1. Executive Summary: Standards of Medical Care in Diabetes-2009.  Diabetes Care 2009; 32 (Suppl 1):S6-12.

2. Van den Berghe G, Wouters P, Weekers F, et al., Intensive Insulin Therapy in Critically Ill Patients.  New England Journal of Medicine 2001; 345(19):1359-1367. 

About the RALS Report

The RALS Report is a benchmarking service provided by Medical Automation Systems and represents the largest data repository for hospital blood glucose measurement in the country. Since 2006, the RALS Report has collected over 80 million patient results and has provided participants with detailed tracking and trending changes in clinical management of glucose by patient unit.

About Medical Automation Systems (www.masinformatics.com)

Medical Automation Systems, Inc. is the country’s premier provider of data management systems used by hospitals to monitor and manage diagnostic testing performed at the patient’s bedside.  Founded in 1994, MAS has a presence in over 1,600 U.S. hospitals. The company’s flagship product, RALS-Plus provides information management for a wide range of point-of-care testing devices. Other products include RALS-Web, providing instant access to POC results through the hospital intranet; and RALS-eQuiz, an on-line training tool with re-certification quizzes and automatic grading. MAS also support websites that provide source and reference materials on the point-of-care industry and glycemic control protocols. Visit www.pointofcare.net, and www.glycemiccontrol.net

About Crozer-Chester Keystone Medical Center (www.crozer.org/CKHS/)

From its beginning in 1990, Crozer-Keystone Health System located minutes from Philadelphia, has been the dominant provider of health care in Delaware County, Pennsylvania, northern Delaware, and part of western New Jersey. The population covered represents almost a million people. Crozer-Keystone provides a full spectrum of wellness, prevention, acute care, rehabilitation and restorative care to the community.

About Central DuPage Hospital (www.cdh.org)

Located in Winfield, Illinois, Central DuPage Hospital provides a full range of inpatient and outpatient care for adults and children, including disease diagnosis, treatment and prevention. The hospital houses 313 licensed beds. Additional outpatient treatment and testing is available at physician practice sites, Convenient Care Centers and other facilities related to Central DuPage Hospital.

About Clarian Arnett Hospital (www.arnett.com/hospital.html)

As part of Clarian Arnett Health, Clarian Arnett Hospital brings high quality health care, and is dedicated to service, convenience and comfort by compassionate professionals in a supportive, family centered, healing environment.