Hyperglycemia Hit Squads: A Special Intervention to Consider

Throughout most of this resource room, we have referred to multidisciplinary teams or steering committees to drive the process of improving care for the hyperglycemic inpatient. This steering committee is charged with evaluating and trending the quality of care delivered to inpatients with diabetes and hyperglycemia and with designing interventions such as protocols, order sets, educational programs, and work flow reorganization to improve this care. Some institutions have gone a step farther by creating a team that targets individual patients or populations of patients in the hospital in a more direct way. These teams, or “hit squads,” can be cost effective. They can be configured in a variety of ways.

Examples of hyperglycemia hit squads:

• A few institutions with a very robust endocrinology presence get endocrinologists involved in the care of almost all hyperglycemic inpatients. Others use well-trained physician assistants or hospitalists to see these patients and to be responsible for all orders regarding diabetes/hyperglycemia and follow-up. At times, this kind of special intervention is focused on select patients (for example, patients in the ICU, perioperative patients, or transplant patients).
• In other institutions, nurse case managers identify patients with hyperglycemia and target them for extra counseling and also target their doctors, urging them to be more aggressive with glycemic control and counseling issues. These professionals will often be enthusiastic and effective members of the medical center’s inpatient hyperglycemia steering committee, and frequently play a role in data collection, as well as being an educational resource for other nurses, physicians, and patients.

You can imagine various combinations of these models and decide if it is feasible to obtain support for them in your special circumstances and with your administration. One thing to emphasize: “hit squads” are an adjunct to, not a replacement for, the other interventions and performance improvement techniques outlined in this resource room. Depending on your institutional environment and baseline, they may be cost effective as well as adding extra power and reliability to many of the other interventions outlined here. Please refer to the Track Performance, The Business Case for Glycemic Control for an in-depth discussion of building the business case to fund a hyperglycemia hit squad.