Multifaceted approach to reducing occurrence
of severe hypoglycemia in a large healthcare system
Creation of dashboards. One of
the first steps taken by the Hypoglycemia
Task Force was to develop dashboards
to display monthly progress,
raise awareness, and garner leadership
support. Data were displayed
graphically as risk-adjusted rates and
counts of severe hypoglycemia events
at the system, hospital, and nursing
unit levels. The dashboard reports
were automatically distributed
monthly to each hospital’s diabetes
management team members and
hospital leaders. In addition, to bring
this concern to the forefront, severe
hypoglycemia events were added to
BJC’s systemwide quality scorecard
beginning in 2011.
An essential component of dashboard
development was the creation
of a metric to adjust for differences
in the patient populations of our
hospitals. To do so, the Hypoglycemia
Task Force developed a metric to
calculate hypoglycemia rates to better
reflect true exposure. This metric,
the “hypoglycemia at-risk rate,” was
calculated by dividing the number
of severe hypoglycemia events (as
defined above) at each BJC hospital
by the number of inpatient days
for any patient with an antidiabetic
agent order.
Development of this risk-adjusted
metric accomplished several goals:
The metric reduced measurement
bias and allowed the task force to
identify high-performing hospitals,
prioritize hospitals for improvement,
and secure a “buy-in” for the hypoglycemia
reduction initiative among
diabetes experts across the system.
This standard metric was applied
across the entire BJC system, which