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Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

By Elizabeth A. Martinez, Raul Chavez-Valdez, Natalie F. Holt, Kelly L. Grogan, Katherine W. Khalifeh, Tammy Slater, Laura E. Winner, Jennifer Moyer and Christoph U. Lehmann

Abstract

Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period

Topics: Clinical Study
Publisher: Hindawi Publishing Corporation
OAI identifier: oai:pubmedcentral.nih.gov:3170784
Provided by: PubMed Central

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Citations

  1. (2001). Agency for healthcare research and quality,” Fact Sheet 01-P017, AHRQ Publication,
  2. (2006). Application of Lean Six Sigma for patients presentingwithST-elevationmyocardialinfarction:theHamilton health sciences experience,”
  3. (2003). Barriers to translating evidence into practice,”
  4. (2007). Basics of quality improvement
  5. (1999). Continuous intravenous insulin infusion reduces the incidenceofdeepsternalwoundinfectionindiabeticpatientsafter cardiac surgical procedures,”
  6. Contribution of early glycemic status in the development of severe retinopathy of prematurity in a cohort of ELBW infants,” Journal of Perinatology.
  7. (2004). Effect of hyperglycemia and continuous intravenous insulin infusions on outcomesofcardiacsurgicalprocedures:thePortlandDiabetic
  8. (2008). Efficacy and safety of modified Yale insulin infusion protocol in Japanese diabetic patients after open-heart surgery,”
  9. (2007). Forum, “Cardiac patients with controlled 6AM postoperative serum glucose,”
  10. (2001). G .v a nd e nB e r g h e ,P .W o u t e r s ,F .W e e k e r se ta l . ,“ I n t e n s i v e insulin therapy in critically ill patients,” The New England
  11. (1997). Glucose control lowers the risk of wound infection in diabetics after open heart operations,”
  12. (2004). Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit,” Diabetes Care,v o l .2 7 ,n o .2 ,p p .
  13. (2006). Implementing an intravenous insulin protocol in your practice: practical advice to overcome clinical, administrative, and financial barriers,”
  14. (2003). Improving communication in the ICU using daily goals,” J o u r n a lo fC r i t i c a lC a r e ,
  15. (2006). Intensive insulin therapy in high-risk cardiac surgery patients: evidence from the Leuven randomized study,”
  16. (2005). Lean sigma—will it work for healthcare?”
  17. (2006). Lean six sigma in healthcare,”
  18. (2006). Pro: lean six sigma revolutionizing health care of tomorrow,”
  19. (2001). Reasons for pediatrician nonadherence to asthma guidelines,”
  20. (2009). Relationships between glucose variability and conventional measures of glycemiccontrolincontinuouslymonitoredpatientswithtype 2diabetes,”HormoneandMetabolicResearch,vol.41,no.2,pp.
  21. (2008). strategies for quality improvement and patient safety,” in Patient Safety and Quality: An Evidence-Based Handbook for Nurses,
  22. (2007). Strict glycemic control reduces EuroSCORE expected mortality in diabetic patients undergoing myocardial revascularization,”
  23. (2008). The six sigma initiative at Mount Sinai medical center,”
  24. (2009). The Society of Thoracic Surgeons practice guideline series: blood glucose management during adult cardiac surgery,”
  25. (2008). Use of serum and plasma glucose measurements as a benchmark for improved hospital-wide glycemic control,”
  26. (1999). Why don’t physicians follow clinical practice guidelines? A framework for10