ABSTRACT
INTRODUCTION: We evaluated the feasibility of using an electronic protocol developed for research use (Research-eProtocol-insulin) for blood glucose management in usual intensive care unit clinical practice. METHODS: We implemented the rules of Research-eProtocol-insulin in the electronic medical record of the Intermountain Healthcare hospital system (Clinical-eProtocol-insulin) for use in usual clinical practice. We evaluated the performance of Clinical-eProtocol-insulin rules in the intensive care units of seven Intermountain Healthcare hospitals and compared this performance with the performance of Research-eProtocol-insulin at the LDS Hospital Shock/Trauma/Respiratory Intensive Care Unit. RESULTS: Clinician (nurse or physician) compliance with computerized protocol recommendations was 95% (of 21,325 recommendations) with Research-eProtocol-insulin and 92% (of 109,458 recommendations) with Clinical-eProtocol-insulin. The blood glucose distribution in clinical practice (Clinical-eProtocol-insulin) was similar to the research use distribution (Research-eProtocol-insulin); however, the mean values (119 mg/dl vs 113 mg/dl) were statistically different (P = 0.0001). Hypoglycemia rates in the research and practice settings did not differ: the percentage of measurements < or =40 mg/dl (0.11% vs 0.1%, P = 0.65) and the percentage of patients with at least one blood glucose < or =40 mg/dl (4.2% vs 3%, P = 0.23) were not statistically significantly different. CONCLUSION: Our electronic blood glucose protocol enabled translation of a research decision-support tool (Research-eProtocol-insulin) to usual clinical practice (Clinical-eProtocol-insulin).
ABSTRACT
A real-time, bedside decision support tool that provides insulin therapy instructions for intensive care unit (ICU) patients was developed at Intermountain Healthcare's LDS Hospital. A team of clinicians, analysts and software engineers were tasked with developing the user interface to run the glucose protocol. Quick, iterative designs involving clinical end-users early in the development process resulted in a tool which was easy to use, facilitated the nursing workflow and was successfully implemented in the hospital's five adult ICUs.
