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Effectiveness of standardised preoperative assessment and patient instructions on admission blood glucose for patients with diabetes undergoing orthopaedic surgery at a tertiary referral hospital
  1. Thérèse Franco MD, SFHM1,
  2. Stephen Rupp MD2,
  3. Barbara Williams PhD3,
  4. Craig Blackmore MD, MPH3
  1. 1Section of Hospital Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
  2. 2Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
  3. 3The Center for Healthcare Improvement Science, Virginia Mason Medical Center, Seattle, Washington, USA
  1. Correspondence to Thérèse Franco MD and SFHM, Section of Hospital Medicine Virginia Mason Medical Center Seattle Washington USA ; Therese.Franco{at}


Diabetes and hyperglycaemia affect a significant number of people and are associated with a variety of untoward effects, especially under physiological stress such as surgery. Due, in large part to limited evidence, clinical practice in monitoring blood glucose and treating hyperglycaemic conditions in the perioperative period is variable. We used Lean methodologies to implement a standardised approach to preoperative management of patients undergoing elective surgery in an effort to improve glycaemic control. Overall, we saw an appropriate increase in monitoring and a decrease in the rate of hyperglycaemia on presentation to the operating room. This approach may be useful in other care settings or patient populations, potentially contributing to improved glycaemic control and subsequent decrease in associated complications.

  • diabetes mellitus
  • surgery
  • lean management
  • prehospital care

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  • 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. TF: subject matter expert in the development of this quality improvement work, and responsible for writing the manuscript. SR: executive and operational team lead for this project, and responsible for review and editing of the manuscript. BW: biostatistician and performed data analysis for this paper; provided editorial input for the manuscript. CB: director of the Center for Healthcare Improvement Science, and, in this role, provided technical guidance for study design as well as editorial input for the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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