ABSTRACT
BACKGROUND: Computer-assisted insulin protocols (CAIPs) contain complex mathematical algorithms to assist with insulin dosing. This study compared the quality of glucose control utilizing a CAIP with a paper-based insulin protocol (PBIP). METHODS: This before-after study identified consecutive patients who received continuous insulin therapy for at least 24 h. Patients were stratified into two groups (PBIP and CAIP). The target blood glucose range for both was 80-110 mg/dL. Hypoglycemia was defined as the percentage of patients with any glucose value <40 mg/dL. Variability was measured by reporting the SD for each patients mean glucose value. RESULTS: There were 192 patients evaluated (PBIP, n = 145; CAIP, n = 47). More glucose readings were within target range using the CAIP protocol (49 ± 14% vs. 40 ± 12%, P < 0.001), but no difference in mean glucose was noted (113 ± 11 mg/dL with CAIP vs. 116 ± 11 mg/dL with PBIP, P = 0.067). The incidence of hypoglycemia was similar between the CAIP and PBIP groups, respectively (2.1% vs. 4.1%, P = 0.518). Glucose variability was lower with the CAIP (25 ± 9 mg/dL vs. 31 ± 11 mg/dL, P = 0.001). The CAIP required more frequent blood glucose assessments (16 ± 2 vs. 12 ± 2 per day, P < 0.001), more insulin dosing adjustments (14 ± 3 vs. 5 ± 2 per day, P < 0.001), and more time per day (84 ± 15 vs. 51 ± 8 min per patient, P < 0.001) compared with the PBIP. CONCLUSIONS: A CAIP will lead to minor improvements in glucose control and decrease glucose variability but will not change the rate of hypoglycemia or response to insulin therapy. These differences could largely be due to more aggressive monitoring and titrations required by a CAIP.
Subject(s)
Blood Glucose/drug effects , Critical Care/methods , Drug Therapy, Computer-Assisted/methods , Hypoglycemia/prevention & control , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Blood Glucose/metabolism , Critical Care/standards , Drug Therapy, Computer-Assisted/standards , Humans , Hypoglycemia/blood , Middle Aged , WorkloadABSTRACT
The annual number of total hip and knee replacements roughly doubled between 1994 and 2004, and this trend is projected to continue. These surgical patients are often older and many have special postsurgical care and rehabilitation needs. However, historically they have been incorporated into the general orthopaedic patient population. The development of centers of excellence in joint replacement has become one method for meeting the special needs of this population. This article describes the journey one midwestern healthcare system has taken in establishing a consolidated, specialized joint replacement center, which has received the Joint Commission's Disease-Specific Care Certification for hip and knee replacement. Specific steps in the development of the center, implementation, evaluation and outcomes, and lessons learned are described.
