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..
