Inpatient severe hypoglycemia (SH), blood glucose (BG) <40 mgs/dl, is associated with morbidity. We previously piloted a predictive model to identify and intervene in inpatients at risk for SH that decreased the rate of SH by 68%. Expanding the alert system-wide to 9 hospitals, succeeded in reducing the occurrence of severe hypoglycemia from 2.9% to 1.7% per 1000 at risk patient days during all visits, and from 4.4% to 2.5% during visits where an alert occurred across all hospitals (both p-values<.001). There were 4142 alerts in 2013; number increased to 5171 in 2014, and stayed steady in 2015 (5161), 2016 (5649), and 2017 (4964).

This study reflects a retrospective analysis of system-wide data from 2011 to 2017. Results show BG levels post alert are higher on average (mean 92.83) than pre-alert (mean 74.43). This magnitude of difference occurs in each year (pre-post differences range from 14.7 to 19.3), suggesting that the alert system led to a sustained beneficial effect over time. A decreasing trend in SH rate over time was observed, which differed by hospital (Figure). System-wide electronic surveillance and alerts improve safety in patients with diabetes across a range of clinical settings. This study proves ongoing efficacy of the alert process and variables.


M. Elliott: None. M.C. Blackburn: None. K.M. Heard: None. P.E. Milligan: None. P. Cruz Bravo: None. G.S. Tobin: Speaker's Bureau; Self; Novo Nordisk Inc., MannKind Corporation. Advisory Panel; Self; Novo Nordisk Inc..

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at