Influence of smart real-time electronic alerting on glucose control in critically ill patients

Abstract Purpose Hyperglycemia and hypoglycemia are frequently encountered in critically ill patients and associated with adverse outcomes. We configured a smart glycemia alert (S-GLY alert) with our Intensive Care Information System to decrease the number of hyperglycemic values and increase the pr...

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Bibliographic Details
Published in:Journal of critical care 2015-02, Vol.30 (1), p.216.e1-216.e6
Main Authors: Colpaert, Kirsten, MD, PhD, Oeyen, Sandra, MD, Sijnave, Bart, PhD, Peleman, Renaat, MD, PhD, Benoit, Dominique, MD, PhD, Decruyenaere, Johan, MD, PhD
Format: Article
Language:English
Subjects:
Aged
Blood Glucose - analysis
Clinical Alarms - statistics & numerical data
Clinical decisions support systems
Computer systems
Controlled Before-After Studies - methods
Critical Care
Critical Illness
Female
Glucose
Glucose control
Health information technology
Homeostasis
Hospital Information Systems
Humans
Hyperglycemia
Hyperglycemia - blood
Hyperglycemia - prevention & control
Hypoglycemia
Hypoglycemia - blood
Hypoglycemia - prevention & control
Hypoglycemic Agents
Insulin
Intensive care unit
Intensive Care Units
Male
Middle Aged
Mortality
Organ Dysfunction Scores
Prospective Studies
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Summary:Abstract Purpose Hyperglycemia and hypoglycemia are frequently encountered in critically ill patients and associated with adverse outcomes. We configured a smart glycemia alert (S-GLY alert) with our Intensive Care Information System to decrease the number of hyperglycemic values and increase the proportion of time within the glucose interval of 80 to 150 mg/dL. Materials and Methods Prospective intervention study in surgical intensive care unit in a tertiary care hospital. An 11-week prealert phase was followed by a 15-week intervention phase where the S-GLY alert was alerting the nurses through the Clinical Notification System of the Intensive Care Information System. Results Overall, 2335 S-GLY alerts were recorded. There were less hyperglycemic values and less persistent hyperglycemic episodes in the alert phase (19.5% vs 26.5% [ P < .001] and 9.9% vs 15.4% [ P < .001], respectively). More time was spent within target glucose interval (82.3% vs 75.0%, P = .009). A lower proportion of patients experienced a new-onset hypoglycemic event (< 70 mg/dL) in the alert phase (9.2% vs 15.2%, P = .016). The Sequential Organ Failure Assessment score was significantly reduced (5.2 vs 4.2, P < .001). Conclusions The implementation of a real-time smart electronic glycemia alert resulted in significantly less episodes of persistent hyperglycemia and a higher proportion of time with normoglycemia, while decreasing the number of hypoglycemic events.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2014.07.030