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Effectiveness of a multi-component quality improvement intervention on rates of hyperglycaemia
PURPOSE: To evaluate the effectiveness of a multifaceted, hospital-wide glycaemic control quality improvement programme. METHODS: The quality improvement intervention comprised three components, derived through root cause analysis: standardising and simplifying care (including evidence-based order s...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5699161/ https://www.ncbi.nlm.nih.gov/pubmed/29450273 http://dx.doi.org/10.1136/bmjoq-2017-000059 |
Sumario: | PURPOSE: To evaluate the effectiveness of a multifaceted, hospital-wide glycaemic control quality improvement programme. METHODS: The quality improvement intervention comprised three components, derived through root cause analysis: standardising and simplifying care (including evidence-based order sets), increasing visibility (through provider access to clinical data and direct feedback) and educational outreach (directed at the entire institution). Effectiveness was determined at a single urban acute care hospital through time-series analysis with statistical process control charts. Primary outcomes included rate of hyperglycaemia and rate of hypoglycaemia. RESULTS: The study included 70 992 hospital admissions for 50 404 patients, with 3 35 645 patient days. The hyperglycaemia ratio decreased 25.2% from 14.1% to 10.5% (95% CI 3.3 to 3.9 percentage points, p<0.001). The ratio of patient days with highly elevated blood glucose (>299 mg/dL) decreased 31.8% from 4.8% to 3.3% (95% CI 1.4 to 1.7 percentage points, p<0.001). Hypoglycaemia ratio decreased from 5.2% to 4.6% (95% CI 0.27 to 0.89 percentage points, p<0.001) in patients with diabetes, but increased in patients without diabetes from 1.2% to 1.7% (95% CI 0.46 to 0.70 percentage points, p<0.001). CONCLUSIONS: We demonstrate improved hospital-wide glycaemic control after a multifaceted quality improvement intervention in the context of strong institutional commitment, national mentorship and Lean management |
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