A virtual glucose management service combines glucose readings and clinical notes into a diabetic patient's EHR/EMR, with recommendations for customizing ideal insulin levels.
A virtual glucose management service (vGMS) for hospitalized patients with diabetes is effective at maintaining appropriate glucose levels, according to a study led by researchers at UC San Francisco.
The study results and were published last month in the Annals of Internal Medicine.
The system combines an automated daily report of all patients experiencing high or low glucose levels with individual reviews by a trained diabetes specialist via the EMR.
The data is integrated into each patient's record, along with a program that customizes ideal insulin levels. The system enables providers who aren't diabetes specialists to immediately know how much insulin to provide, the university said.
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"With this new system, there has been a 39% decrease in patients on the daily high-glucose hospital report," lead author Robert Rushakoff, MD, MS, professor of medicine at UCSF and medical director for inpatient diabetes at UCSF Medical Center, said in a statement.
Cost Savings
"The vGMS and similar inpatient services leveraging technology may also become economically important for cost savings, as medicine moves toward bundled care."
The researchers analyzed 12,535 non-obstetric adult patients at three UCSF Medical Center hospitals who had two or more elevated or lowered glucose values in the previous 24 hours, as identified by a daily glucose report.
The analysis was conducted during three 12-month periods from June 2012 to May 2015. Now, the UCSF Medical Center vGMS continues to operate without interruption.
Recommendations and Results
Automated glucose reports, clinician review, and clinical notes comprise the vGMS.
By 5:30 each morning, the vGMS system generates an automated daily report of all inpatients with uncontrolled blood glucose. The report is then reviewed remotely by a diabetes specialist, along with an insulin/glucose chart, via the EHR/EMR.
The vGMS note is available for clinician review by 6:30 each morning. It contains a disclaimer indicating that the information within is solely a recommendation, and advises the treating team to take into account the patient's current clinical condition and obtain a formal endocrinology consultation if necessary.
Within the vGMS template are drop-down boxes with specific recommendations based on whether the patient has been eating or receiving glucocorticoids or enteral feedings, followed by suggested insulin doses.
According to the study:
- The proportion of hyperglycemic patients decreased 39%
- The hypoglycemic proportion in the vGMS period was 36% lower than in the pre-vGMS period
- 40 severe hypoglycemic events occurred during the pre-vGMS period and only 15 during the vGMS period
"The whole process takes about 45 minutes," Rushakoff said.
"If you had a formal consult service to intervene on these patients, it would take all day to see everyone and then talk to the teams. The note also reinforces the training of resident physicians just at the time it is needed, and improvements then can be made for that patient and future patients."
Alexandra Wilson Pecci is an editor for HealthLeaders.
