550-P: Utilization of an Electronic Clinical Decision Support Tool by Health Care Providers for Hospital Glycemic Management in a Large Academic Center

Introduction: Sequelae of dysglycemia include infections and non-infectious complications, longer hospitalizations, and added hospital expenditure. Clinical Decision Support (CDS) is linked to optimization of glycemic control and shorter hospital stay. However, knowledge about clinicians’ responsiveness to CDS for diabetes care is limited.

Objective: This study aims to evaluate response to an inpatient electronic health record (EHR) CDS tool that detects gaps in glycemic care in real-time, and offers notifications containing evidence-based management recommendations.

Methods: We conducted abstractions of 65 patients’ charts with notifications delivered to providers related to persistent hyperglycemia, hypoglycemia or near hypoglycemia, or insulin sliding scale monotherapy. We calculated the proportion of response to CDS recommendations.

Results: Insulin reduction after alerts for or near hypoglycemia (≤80 mg/dL) or hypoglycemia risk (81-100 mg/dL) was 0% and 16.7% respectively. Insulin was initiated (50%) or increased (33%) after notifications for hyperglycemia (180 mg/dl x 2) in patients with diabetes, and initiated (60%) for stress hyperglycemia. After alerts for sliding scale monotherapy, insulin was initiated (53%) or stayed the same (55%).

Conclusions: There were variable reactions to CDS prompts. Even though our program is characterized by a standardized process that presents evidence-based real-time recommendations in the context of practice, uses a knowledge-promoting approach, and delivers automated prompts in the EHR, the overall response was noted to be limited. This phenomenon is likely multifactorial and requires closer investigation. CDS programs can benefit from careful assessment of users’ engagement, notification burden, and implementation strategies. Further, assessment of programs’ design to foster adoption of guidelines and evidence-based recommendations is warranted.