You are here

Article Text

Article menu

Download PDFPDF

XML
BMJ Quality Improvement Report
Effectiveness of a multi-component quality improvement intervention on rates of hyperglycaemia
  1. Thérèse Franco1,
  2. Barry Aaronson1,
  3. Laurel Brown2,
  4. Craig Blackmore3,
  5. Stephen Rupp4,
  6. Grace Lee1
  1. 1Department of Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
  2. 2Department of Pharmacy, Virginia Mason Medical Center, Seattle, Washington, USA
  3. 3Center for Health Care Improvement Science, Virginia Mason Medical Center, Seattle, Washington, USA
  4. 4Department of Anesthesia, Virginia Mason Medical Center, Seattle, Washington, USA
  1. Correspondence to Dr Thérèse Franco; Therese.Franco{at}virginiamason.org

Abstract

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

  • hospital medicine
  • quality improvement
  • lean management

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjoq-2017-000059

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors All authors participated in the design of the quality improvement work, the project evaluation design and analysis, the manuscript writing and editing and approved the final submission.

    • Competing interests None declared.

    • Ethics approval This investigation was performed as a quality improvement project with waiver from the institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.