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Stop the Revolving Door: An ED-based Intervention to Improve the Treatment of Uncontrolled Diabetes
Context:
Patients with undiagnosed Type 2 Diabetes (T2D) often first present to the Emergency Department (ED), but if they are not in ketoacidosis (DKA) or in a hyperosmolar state (HHS), they are usually discharged with variable treatment or follow-up. Many patients with poorly controlled known T2D also are frequent utilizers of the ED, but they seldom benefit from acute treatment and release practices. We developed electronic health record (EHR) alerts and an observation stay protocol to improve the ED treatment of patients with poorly controlled known or new T2D.
Research Question:
Do EHR alerts improve the screening of poorly controlled known or new T2D (HbA1c ) in the ED and does a dedicated protocol in the observation unit result in better glycemic control and follow-up care?
Methods:
We are conducting a pragmatic, interrupted time series trial at a large, urban academic medical center using an EHR-based, alert-driven protocol for patients presenting to the ED with hyperglycemia (glucose ≥ 250 mg/dL). The first alert suggests ordering an HbA1c test—if the HbA1c is ≥ 10%, a second alert recommends admission to the observation unit for intensive glucose control, diabetes education, endocrinology consultation, and medication titration. We will be assessing adherence with the recommended ED treatment protocol, receipt of a T2D-related follow-up appointment within 4 weeks, and HbA1c 1% reduction in 3 months.
References
References
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