Minutes for Inpatient Conference Call:

Can Joslin improve inpatient quality in your hospital?

7/26/06

Facilitator: Elaine Sullivan (Jamie Rosenzweig, MD, will not be joining the call. We will reschedule him for a call after the Joslin Inpatient Clinical Guidelines & Infusion protocols are published.)

Participants:

Baltimore Washington Medical Center, Glen Burnie, MD

Fremont Medical Centers, Las Vegas, NV

Lawrence and Memorial Hospital, Mystic and New London, CT

Maryland General Hospital, Baltimore, MD

New Britain General Hospital, New Britain, CT

Southern New Hampshire Medical Center, Nashua, NH

St. Mary's Medical Center, Huntington, WV

St. Mary's, Evansville, IN

St. Vincent Charity Hospital, Cleveland, OH

SUNY Upstate Medical University, Syracuse, NY

Swedish Medical Center, Seattle, WA

University of Maryland, Baltimore, MD

Western Pennsylvania Hospital, Pittsburgh, PA

  1. Why should we focus on inpatient hyperglycemia/diabetes care?

DM prevalence in Affiliate hospitals is 17 – 60%; many Affiliates not sure of prevalence; need baseline data; some Affiliates get printouts of people with diabetes or lab can access hyperglycemia stats.

You need to know your own hospital’s baseline data before you intervene.

According to the literature DM as a secondary diagnosis causes increased LOS; hyperglycemia increases in-hospital mortality 18 fold; JCAHO is now focused on inpatient diabetes.

SUNY has recently gotten consensus from all 6 ICUs and endocrinologists to use Portland protocol; evidence spoke for itself re need for infusion protocol and tight glucose control; agreement that multiple protocols were safety risk; will be evaluating impact; don’t plan to use Portland protocol on non-ICU floors because too labor intensive.

  1. Who in your organization has reviewed the new Joslin Inpatient Manual and what was reaction?

Manual is timely and process makes sense per several Affiliates. Swedish will use it to

meet hospital 100,000 Lives Campaign through IHI; at Maryland General senior

management is reviewing.

It is important to get the manual off the shelf and into the hands of people

who can help to move the process forward.

  1. Have you identified champions in your organization? Talk about champion’s ability to influence physicians, senior management and nurses.

SUNY – JDC educator and Fellow have been identifying and forming an Inpatient Advisory Group including administrator, physician, nurse and dietitian representatives as a preliminary step to develop buy in and influence.

SNH & L&M – JDC Medical Director developed order sets to standardize care; JDC educator provides staff and patient education.

Discussion of developing unit based diabetes resource nurses:

SUNY – has 1 unit based nurse who has been very influential on her unit but would need all units and all shifts covered

UMM – JDC educator offering formal staff education in DM so unit

nurses won’t depend on specialists; Joslin RN ½ time with staff ed focus

Seattle – seen both approaches over the years; prefer to use JDC educator expertise to develop general nurse competencies

MGH – general nurses interested in developing expertise in DM to be unit based resource nurses; may make sense because high

prevalence of diabetes

Need for realistic expectations of Joslin educator role in inpatient care

Need for online staff education per Seattle; SUNY using “blackboard”; Dianna Cotterell at UMM has developed an online inpatient staff nurse course; may be useful to other Affiliates; Boston will follow up on this

There is agreement that senior management support is essential to success.

  1. What components of the Joslin program are your hospitals considering using? Are you willing to partner with us to pilot components of the manual?

All components of the manual can be used without partnering with Boston to pilot test.

SNH, Seattle, MGH and SUNY are interested in pilot testing. Some Affiliates want to know specifics of pilot projects; we are currently trying to assess interest before designing pilots.

The critical thing is to measure pre and post intervention to demonstrate value to the system.

  1. If your hospital is considering application for JCAHO Recognition of Inpatient Diabetes Care, how do you plan to meet the requirements?

SNH is planning to apply. They would like to pilot some components of the manual with Boston. They have already done a lot of preliminary work.

JCAHO website for information on Inpatient Diabetes Recognition

  1. Talk about Information Service and Quality/Risk Management support available to help with data collection and analysis.

Not covered on the call but very important to investigate during planning phase

Call Elaine Sullivan with your hospital’s pilot ideas. We hope to have a few formal

pilot tests ready for announcement at October’s Annual Meeting.

Some Pilot Ideas (not discussed during conference call)

Trial use of Getting Started CQI Checklist - identify usefulness of tool, barriers and

strategies to overcome barriers

Identify methods to track baseline data (see Tracking Inpatient Hyperglycemia CQI

Outcomes) and analyze post intervention data for a minimum of 1 year

Do chart audit pre and post use of Diabetes Medical Record Documentation form

Conduct Inpatient physician and nurse satisfaction surveys pre and post intervention

Implement an insulin infusion protocol and track impact

Implement nurse core competency checklist for diabetes at baseline and after intervention

Present formal diabetes staff education, summarize evaluations and propose revisions to curriculum, slide set and handouts

Determine which slides are most useful for patient education at the bedside, trial bedside flip chart, gather and summarize data on Diabetes Medical Record Documentation form

Apply for JCAHO Recognition of Inpatient Diabetes Care using Joslin manual and Boston support to facilitate process

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