An Innovative Cost-Effective Model of Using Advanced Care Practitioners (ACPs) in Improving Glycemic Control and LOS in a Large Hospital System

Abstract

In 2001 healthcare systems identified issues related to increased length of stay and suboptimal outcomes associated with poor inpatient glycemic control. Diabetes clinical initiative (DCI) team was created and the physician champion developed protocols and restructured the delivery of diabetic care across the healthcare system. However it was difficult to provide uninterrupted service due to shortage of Endocrinologists. An innovative care model was designed in 2009 using specialty trained Endocrinology ACPs’ to improve Glycemic control across system and to provide uninterrupted service including weekends. The ACP’s were trained by the physician champion both with didactic teachings and ongoing case discussions. Automatic consults to ACPS’ were initiated for specific criteria identified by lead physicians .These criteria included HbA1C more than 8.5,Blood Glucose (BG) greater than 200 X4 in 24 hours, BG greater than 300 x2 in 24 hours and Hypoglycemia less than 40x2 in 24 hours .The ACPs’ were always supported by the endocrinology team . For the last 8 years the glycemic control across the hospital has further improved from average blood glucose of 160-153mg/dl. The rate of mild hypoglycemia remains low at 2% and severe hypoglycemia at < 0.4% . This has resulted in continuation of improved LOS and patient satisfaction as well. Much improved results in Coronary artery bypass surgery (CABG) population have been shown with no deep sternal wound infections in last 6 years. The model remains cost effective for the whole system. Summary: Innovative model of Glycemic control using specialty trained ACPS’ is cost effective and improves glycemic control and LOS. The ongoing education and support is critical to the success of the program. Disclosure R. Joshi: None. A. Helmuth: None.