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 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Nya-Ngatchou, J. J., Corl, D., Onstad, S., Yin, T., Tylee, T., Suhr, L., Thompson, R. E., & Wisse, B. E. (2015). Point-of-care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients. Diabetes/Metabolism Research and Reviews, 31(2), 147-154. https://doi.org/10.1002/dmrr.2575