THU290 Identifying Trends In Glycemic Management In A Comprehensive Cancer Center

Abstract

Abstract Disclosure: N. Kikani: None. S. Thosani: None. Hyperglycemia in the inpatient setting contributes to morbidity and mortality. Glycemic management in the emergency room is the gateway for inpatient management. An institutional quality improvement initiative to improve glycemic management was initiated in January 2020. Interventions included a diabetes related questionnaire at triage triggering a mandatory point of care (POC) glucose check if positive and the addition of quick access acute hyperglycemia orders in the emergency management electronic medical record (EMR) order set. In this study, we gathered baseline glycemic data on patient visits to urgent care center from January 2019-November 2022 to explore trends in monitoring and management prior to and after the implementation of initiative. The highest value of glucose documented per encounter was utilized for calculations. During this period, an average of 1,912 individual patients were evaluated and accounted for 2,239 visits per month. For the entire patient population, 7% of visits were characterized by glucose values between 200-249mg/dL, 3% of visits with glucose values between 250-299 mg/dL, and 2% with glucose values ≥300mg/dL. 59% of visits resulted in inpatient admission and 25% of admitted patients had point of care glucose monitoring orders. 17.8% of patients had known diabetes and on average, 24%, 13% and 8% of these patient visits were characterized by glucose between 200-249 mg/dL, 250-299 mg/dL and ≥300mg/dL respectively. 64% of visits culminated with inpatient admission with 46% of admitted patients having POC glucose monitoring orders and 79% of patients with insulin orders on admission. In 2019, a mean of 25% of total admitted patient encounters had a POC glucose order on admission compared to 21% in 2020, 25% in 2021, and 30% in 2022. Of those patient encounters with known diabetes, 49%, 39%, 43%, 52% had a POC glucose order on admission in the years 2019, 2020, 2021, and 2022 respectively. Of the encounters with patients with known diabetes, 37% were admitted with an insulin sliding scale order in 2019, 26% in 2020, 26% in 2021, and 36% in 2022. In 2019, 76% of encounters with diabetes patients had an insulin order on admission, 80% in 2020, 79% in 2021, and 79% in 2022. Over the four years, the mean distribution of POC blood glucose values remained stable across both the general and diabetes specific populations. The admission rate for both these populations also had little variability. Of the patients with diabetes, the rate of POC glucose order at admission increased from 49% to 52%. Those with an insulin order remained stable from 76% to 79%. Additionally, only 26% to 37% of patients with diabetes were admitted with an insulin sliding scale order. These trends provide valuable insight into areas that may be targeted for early intervention in glycemic management which has the potential to improve hospital outcomes in patients with diabetes mellitus. Presentation: Thursday, June 15, 2023