V. N. O’Reilly-Shah1,2, E. W. Duggan1, G. C. Lynde1 1Emory University School Of Medicine,Anesthesiology,Atlanta, GA, USA 2Children’s Healthcare Of Atlanta,Pediatric Anesthesiology,Atlanta, GA, USA
Introduction: The association between perioperative hyperglycemia and adverse clinical outcomes is well established [1-3]. Evidence indicates that improved glycemic control reduces hospital complications and decreases mortality in general surgery patients [4,5]. To promote inpatient glycemic control in non-cardiac surgical patients, a screening/treatment algorithm was developed at a tertiary-care academic hospital.
Methods: Several tools were advanced to increase clinician adherence to the algorithm including screening order sets and an mHealth clinical decision tool for Android and iOS (Figure 1). Preoperative screening began in May 2016. After beta testing and review, the mHealth tool was launched November 2016. The cloud-integrated Survalytics platform was integrated into the app, collecting in-app analytics and user demographics. Statistical analysis was performed in R [6].
Results: Screening was completed for 2858 patients; 691 with diagnosed diabetes. Of those considered at-risk, 32.8% were identified with undiagnosed diabetes or prediabetes. Prevalence of BG > 180mg/dL increased with higher HgbA1C. Adherence to insulin treatment for BG > 180mg/dL was 81% for diagnosed diabetics and 48% in undiagnosed disease. Growing use of the app provides more facile access to treatment recommendations based on patient diagnosis and risk. Further exploration between app use, inpatient glycemic control and provider behaviors will be followed.
Conclusion: This work demonstrates an evidence-based algorithm to identify surgical patients at risk for perioperative hyperglycemia .The mHealth tool provides up-to-date screening and treatment recommendations, and provides rapid feedback to improve inpatient glycemic control and positively impact clinician decision-making.
