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Impact of a computer-generated alert system on the quality of tight glycemic control

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Abstract

Purpose

To assess the impact of a computer-generated blood glucose (BG) alert, generated by a Patient Data Management System (PDMS) and superimposed on a paper-based guideline, on tight glycemic control (TGC) in the intensive care unit (ICU).

Methods

TGC in the Leuven University Hospitals is performed by nurses using a paper-based guideline that allows anticipative, intuitive decision-making. An electronic alert was implemented on 1 August 2007 in which a pop-up appears in the PDMS at the following BG thresholds: >180, >110, 60–80, 40–60 and <40 mg/dl. The impact of this electronic alert was assessed by a sequential cohort study: the mean BG, the glycemic penalty index (GPI), the hyperglycemic index (HGI), the number of hypoglycemic events, the standard deviation (SD) of the BG time series and the number of BG measurements were compared in all adults admitted 6 months before (‘pre-alert group’, n = 729) and after (‘alert group’, n = 644) the implementation of the electronic alert.

Results

The alert resulted in a reduction of mean BG (112 vs. 110 mg/dl, p = 0.002), GPI (20 vs. 19, p = 0.029) and HGI (10 vs. 9 mg/dl, p = 0.004), without increasing BG sampling (median 25 measurements/patient in both groups, p = 0.776). The alert reduced the proportion of patients experiencing an episode of hypoglycemia from 6.5 to 4.0% (p = 0.043). The SD of the BG time series was not affected (28 mg/dl in both groups, p = 0.566).

Conclusion

A computer-generated alert was able to statistically significantly improve the quality of TGC in ICU patients without increasing the need for blood sampling.

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Acknowledgments

We thank Prof. Dr. Dieter Mesotten for proofreading the manuscript. This work was presented in part as an abstract at the 29th International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium on 24 March 2009. The work was funded by the Research Fund of the University of Leuven (GOA 2007/14), a doctoral fellowship to GM from the Belgian Fund for Scientific Research Flanders (FWO) and by long-term structural funding to GVdB via the Methusalem program of the Flemish Government. The work was supported by the Fund for Scientific Research (FWO), Flanders, Belgium (G.0533.06 and G.0310.08), the Research Council of the Katholieke Universiteit Leuven (GOA/2007/14), and the Methusalem Programme from the Flemish Government to GVdB. GM was a doctoral fellow of the Fund for Scientific Research (FWO), Flanders, Belgium (1700809 N).

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium

    Geert Meyfroidt, Pieter Wouters, Wilfried De Becker, Dominiek Cottem & Greet Van den Berghe

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  1. Geert Meyfroidt
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  2. Pieter Wouters
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  3. Wilfried De Becker
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  4. Dominiek Cottem
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  5. Greet Van den Berghe
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Correspondence to Geert Meyfroidt.

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Meyfroidt, G., Wouters, P., De Becker, W. et al. Impact of a computer-generated alert system on the quality of tight glycemic control. Intensive Care Med 37, 1151–1157 (2011). https://doi.org/10.1007/s00134-011-2159-7

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