Point-of-care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients

Jean Jacques Nya-Ngatchou, Dawn Corl, Susan Onstad, Tom Yin, Tracy Tylee, Louise Suhr, Rachel E. Thompson, Brent E. Wisse

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Hypoglycaemia is associated with morbidity and mortality in critically ill patients, and many hospitals have programmes to minimize hypoglycaemia rates. Recent studies have established the hypoglycaemic patient-day as a key metric and have published benchmark inpatient hypoglycaemia rates on the basis of point-of-care blood glucose data even though these values are prone to measurement errors. Methods: A retrospective, cohort study including all patients admitted to Harborview Medical Center Intensive Care Units (ICUs) during 2010 and 2011 was conducted to evaluate a quality improvement programme to reduce inappropriate documentation of point-of-care blood glucose measurement errors. Laboratory Medicine point-of-care blood glucose data and patient charts were reviewed to evaluate all episodes of hypoglycaemia. Results: A quality improvement intervention decreased measurement errors from 31% of hypoglycaemic (<70 mg/dL) patient-days in 2010 to 14% in 2011 (p<0.001) and decreased the observed hypoglycaemia rate from 4.3% of ICU patient-days to 3.4% (p<0.001). Hypoglycaemic events were frequently recurrent or prolonged (~40%), and these events are not identified by the hypoglycaemic patient-day metric, which also may be confounded by a large number of very low risk or minimally monitored patient-days. Conclusions: Documentation of point-of-care blood glucose measurement errors likely overestimates ICU hypoglycaemia rates and can be reduced by a quality improvement effort. The currently used hypoglycaemic patient-day metric does not evaluate recurrent or prolonged events that may be more likely to cause patient harm. The monitored patient-day as currently defined may not be the optimal denominator to determine inpatient hypoglycaemic risk.

Original languageEnglish (US)
Pages (from-to)147-154
Number of pages8
JournalDiabetes/Metabolism Research and Reviews
Volume31
Issue number2
DOIs
StatePublished - Feb 1 2015

Fingerprint

Point-of-Care Systems
Hypoglycemia
Critical Illness
Blood Glucose
Hypoglycemic Agents
Quality Improvement
Intensive Care Units
Documentation
Inpatients
Patient Harm
Benchmarking
Cohort Studies
Retrospective Studies

Keywords

  • Critical illness
  • Diabetes
  • Glycaemic control
  • Insulin
  • Quality improvement

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Point-of-care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients. / Nya-Ngatchou, Jean Jacques; Corl, Dawn; Onstad, Susan; Yin, Tom; Tylee, Tracy; Suhr, Louise; Thompson, Rachel E.; Wisse, Brent E.

In: Diabetes/Metabolism Research and Reviews, Vol. 31, No. 2, 01.02.2015, p. 147-154.

Research output: Contribution to journalArticle

Nya-Ngatchou, JJ, Corl, D, Onstad, S, Yin, T, Tylee, T, Suhr, L, Thompson, RE & Wisse, BE 2015, 'Point-of-care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients', Diabetes/Metabolism Research and Reviews, vol. 31, no. 2, pp. 147-154. https://doi.org/10.1002/dmrr.2575
Nya-Ngatchou, Jean Jacques ; Corl, Dawn ; Onstad, Susan ; Yin, Tom ; Tylee, Tracy ; Suhr, Louise ; Thompson, Rachel E. ; Wisse, Brent E. / Point-of-care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients. In: Diabetes/Metabolism Research and Reviews. 2015 ; Vol. 31, No. 2. pp. 147-154.
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abstract = "Background: Hypoglycaemia is associated with morbidity and mortality in critically ill patients, and many hospitals have programmes to minimize hypoglycaemia rates. Recent studies have established the hypoglycaemic patient-day as a key metric and have published benchmark inpatient hypoglycaemia rates on the basis of point-of-care blood glucose data even though these values are prone to measurement errors. Methods: A retrospective, cohort study including all patients admitted to Harborview Medical Center Intensive Care Units (ICUs) during 2010 and 2011 was conducted to evaluate a quality improvement programme to reduce inappropriate documentation of point-of-care blood glucose measurement errors. Laboratory Medicine point-of-care blood glucose data and patient charts were reviewed to evaluate all episodes of hypoglycaemia. Results: A quality improvement intervention decreased measurement errors from 31{\%} of hypoglycaemic (<70 mg/dL) patient-days in 2010 to 14{\%} in 2011 (p<0.001) and decreased the observed hypoglycaemia rate from 4.3{\%} of ICU patient-days to 3.4{\%} (p<0.001). Hypoglycaemic events were frequently recurrent or prolonged (~40{\%}), and these events are not identified by the hypoglycaemic patient-day metric, which also may be confounded by a large number of very low risk or minimally monitored patient-days. Conclusions: Documentation of point-of-care blood glucose measurement errors likely overestimates ICU hypoglycaemia rates and can be reduced by a quality improvement effort. The currently used hypoglycaemic patient-day metric does not evaluate recurrent or prolonged events that may be more likely to cause patient harm. The monitored patient-day as currently defined may not be the optimal denominator to determine inpatient hypoglycaemic risk.",
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AU - Corl, Dawn

AU - Onstad, Susan

AU - Yin, Tom

AU - Tylee, Tracy

AU - Suhr, Louise

AU - Thompson, Rachel E.

AU - Wisse, Brent E.

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N2 - Background: Hypoglycaemia is associated with morbidity and mortality in critically ill patients, and many hospitals have programmes to minimize hypoglycaemia rates. Recent studies have established the hypoglycaemic patient-day as a key metric and have published benchmark inpatient hypoglycaemia rates on the basis of point-of-care blood glucose data even though these values are prone to measurement errors. Methods: A retrospective, cohort study including all patients admitted to Harborview Medical Center Intensive Care Units (ICUs) during 2010 and 2011 was conducted to evaluate a quality improvement programme to reduce inappropriate documentation of point-of-care blood glucose measurement errors. Laboratory Medicine point-of-care blood glucose data and patient charts were reviewed to evaluate all episodes of hypoglycaemia. Results: A quality improvement intervention decreased measurement errors from 31% of hypoglycaemic (<70 mg/dL) patient-days in 2010 to 14% in 2011 (p<0.001) and decreased the observed hypoglycaemia rate from 4.3% of ICU patient-days to 3.4% (p<0.001). Hypoglycaemic events were frequently recurrent or prolonged (~40%), and these events are not identified by the hypoglycaemic patient-day metric, which also may be confounded by a large number of very low risk or minimally monitored patient-days. Conclusions: Documentation of point-of-care blood glucose measurement errors likely overestimates ICU hypoglycaemia rates and can be reduced by a quality improvement effort. The currently used hypoglycaemic patient-day metric does not evaluate recurrent or prolonged events that may be more likely to cause patient harm. The monitored patient-day as currently defined may not be the optimal denominator to determine inpatient hypoglycaemic risk.

AB - Background: Hypoglycaemia is associated with morbidity and mortality in critically ill patients, and many hospitals have programmes to minimize hypoglycaemia rates. Recent studies have established the hypoglycaemic patient-day as a key metric and have published benchmark inpatient hypoglycaemia rates on the basis of point-of-care blood glucose data even though these values are prone to measurement errors. Methods: A retrospective, cohort study including all patients admitted to Harborview Medical Center Intensive Care Units (ICUs) during 2010 and 2011 was conducted to evaluate a quality improvement programme to reduce inappropriate documentation of point-of-care blood glucose measurement errors. Laboratory Medicine point-of-care blood glucose data and patient charts were reviewed to evaluate all episodes of hypoglycaemia. Results: A quality improvement intervention decreased measurement errors from 31% of hypoglycaemic (<70 mg/dL) patient-days in 2010 to 14% in 2011 (p<0.001) and decreased the observed hypoglycaemia rate from 4.3% of ICU patient-days to 3.4% (p<0.001). Hypoglycaemic events were frequently recurrent or prolonged (~40%), and these events are not identified by the hypoglycaemic patient-day metric, which also may be confounded by a large number of very low risk or minimally monitored patient-days. Conclusions: Documentation of point-of-care blood glucose measurement errors likely overestimates ICU hypoglycaemia rates and can be reduced by a quality improvement effort. The currently used hypoglycaemic patient-day metric does not evaluate recurrent or prolonged events that may be more likely to cause patient harm. The monitored patient-day as currently defined may not be the optimal denominator to determine inpatient hypoglycaemic risk.

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