Stick with What Works


A new study that found tighter glycemic control in ICU patients who received continuous insulin infusion (CII) via computer-guided algorithms versus paper-based protocols might not be enough to ditch paper forms just yet, one of the report's authors says.

While the review in this month's multicenter, randomized trial also reported no differences between groups in length of stay (P=0.704), ICU stay (P=0.145), or in-hospital mortality (P=0.561).

"It leaves it up to the individual physician to decide," Dr. Newton says. "'Is what we're doing working good enough to do what we need to do? Or do we need to make a change?'"

Nationwide, glycemic control is a quality initiative frequently tackled by HM groups. To wit, SHM this year enrolled the first sites into its Glycemic Control Mentored Implementation program. The pilot program addresses subcutaneous insulin protocols, transition from subcutaneous to infusion, care coordination, improving follow-up care, and hypoglycemia management.

And while those institutions and hospitalists focusing on glycemic control will be keen to see the data comparing computer-based and standard column-based algorithms, Dr. Newton says, it will require continued research to determine how each protocol performs in patient safety measures before hospitalists change their habits.

"Honestly, I don't know if [the current research] is [enough]," Dr. Newton says. "If their approach is working … then it's probably not worth making a large investment to cause an upheaval of their whole system at this time."

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