Essential First Steps

Introduction: Recognizing and Defining the General Quality Problem

Quality improvement projects should always develop from recognition of a gap between the level of care that is optimal and best supported by the evidence contrasted with the care that is actually being delivered to our patients.

Optimal Care for the Hyperglycemic Inpatient

Team leaders need to be thoroughly familiar with the principles of the management of diabetes and hyperglycemia in hospitals. Reviewing the appropriate sections in the Glycemic Control Resource Room, including these important reviews, position papers, and guidelines, and reviewing the annotated bibliography of key literature in the Glycemic Control Room should bring you up to date quickly if you are not already well versed in this literature. (Section II highlights other factors that make up optimal care, but this more detailed examination can wait for now.)

Looking into the Gap

Analyze Care Delievery lets you to delve into the details of the care you currently provide and to recognize opportunities for improvement, while the metrics needed to accurately and reliably measure the quality of care your patients enjoy is fully outlined in the Track Perfomance section. A multidisciplinary approach and institutional support are needed to really complete these sections. You may already have successfully used your own methods for convincing yourselves and your administration that inpatients with diabetes/hyperglycemia receive suboptimal care (either by anecdote or hard data) to such a degree that you have already garnered full institutional support and a complete multidisciplinary team. If this is not the case, however, how are you to convince colleagues and the administration that the care currently being delivered is suboptimal, and galvanize full participation in your cause? A quick review of a small selection of patients with hyperglycemia can provide you with some numbers to convey the reality, size, and scope of the problem to others, and help you enlist members to a multidisciplinary team to address the rational and safe use of insulin in your medical center.

View What's the Problem? Ideas for Early Data Collection which offers some ideas about how to collect early data that is suitable for this task in both the critical care and non-critical care areas, often with very small samples of patients. Additional anecdotes or incidents reflecting unsafe medication use and hypoglycemia in your setting can be powerful additions to make the case for support. Methodological rigor is not as important at this stage, as you are only trying to gather enough information to form a committed multidisciplinary team and gain enough institutional support to get started. Talking Points to Gain Institutional Support, should provide you with more evidence for making glycemic control and proper insulin use a priority with your medical center administration and clinical leadership, along with The Business Case for Glycemic Control section, which addresses financial aspects.