Optimizing Patients with Diabetes in the Intraoperative Setting

Abstract

Problem: Over 25% of patients with type-2 diabetes will require surgery at least once in their lifetime. Ineffective intraoperative glycemic control heightens impaired wound healing, surgical site infections (SSI), and stroke. At a community hospital in Maryland, 80% of patients with diabetes undergoing surgery demonstrate elevated blood glucose during the peri-operative period. Purpose: The purpose of this quality improvement project is to implement an evidencebased standardized intraoperative glycemic control guideline over 15 weeks to reduce intraoperative hyperglycemia in all diabetic patients undergoing surgery. Methods: Education was provided to all involved staff following approval of the guideline by anesthesia leadership. The guideline was posted in each operating room and in front of each anesthesia machine as a reference, reminding providers to check glucose every 90 minutes. The Quality Improvement Project Lead collaborated with the site team and monitored the project weekly to facilitate and mitigate any barriers. The Quality Improvement Project. Glucose data was retrieved on 137 eligible surgical patients with diabetes by chart audit, recorded in REDcap, analyzed weekly and reported to stakeholder for feedbackl. Results: Weekly guideline adherence ranged from 55– 92%, with an average rate of 79.7%. A favorable adherence shift occurred between weeks 8–15, reflecting special cause variation. Weekly mean glucose ranged from 122–199 mg/dl, with a favorable trend observed between weeks 11–15, reflecting special cause variation. Glucose was optimized, defined as 70–190 mg/dL, 60%–100% of the time. Conclusions: Guideline driven care is an effective approach to intraoperative glycemic management in surgical patients with diabetes. The project enhanced care by providing an evidence-based structured process for anesthesia providers and favorably impacted glycemic control.