SHM Converge Scientific Abstract ePoster Gallery-Optimizing Inpatient Diabetes Management by Improving Frequency of Appropriate Admission A1c Orders

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This Mayo Clinic Florida quality improvement project aimed to improve inpatient diabetes management by increasing appropriate hemoglobin A1c orders for admitted patients with diabetes when no A1c had been documented in the prior 90 days. Current ADA guidelines recommend inpatient A1c testing in this setting to guide treatment and discharge planning.<br /><br />Baseline review of 74 diabetic patients on internal medicine teaching services showed that only 16 of 49 patients without a recent A1c (32.6%) received an appropriate admission A1c order. In addition, 3 of 25 patients with a recent A1c (12%) had unnecessary repeat testing. The team used a fishbone diagram, impact/effort grid, stakeholder analysis, and resident surveys to identify key causes, including limited guideline knowledge and difficulty finding prior A1c values in the electronic record.<br /><br />Interventions were implemented in two phases: an educational session for residents and a SmartPhrase built into Epic that automatically displayed the most recent A1c and suggested consultation indications. After three PDSA cycles, appropriate A1c ordering improved to 52.4%, and inappropriate repeat ordering dropped to zero.<br /><br />The project highlighted the importance of interdisciplinary collaboration among residents, endocrinology, diabetes educators, IT, and nursing. A program-wide SmartPhrase rollout was viewed as more effective than education alone, since the educational session reached only residents present at the time. The team plans to hand off the intervention to chief residents and the hospital Diabetes Oversight Group, with monitoring every six months. If performance drops by 20% from the new baseline, repeat education, resident surveys, and renewed SmartPhrase promotion will be used to restore gains.

Asset Subtitle

Matthew E. Kornas

Meta Tag

Author List Allyson McNally, Blake McKinley, Brittany Jackson, Carlie Aurubin, Chase Cottle, Christy Tisdall, Colt Cowdell, Guy Robinson, Madeleine Howard, Matthew E. Kornas, McKendree Tozzolo, Nichole Henkes, Rex-Kam Siu

Category Research

Concept Admission A1C

Concept Hemoglobin A1c Test Ordering

Concept Hospitalized Patients with Diabetes

Concept Hyperglycemia

Concept Root Cause Analysis

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Matthew E. Kornas

Track Quality Improvement

Keywords

inpatient diabetes management

hemoglobin A1c orders

Mayo Clinic Florida

quality improvement

ADA guidelines

electronic health record

SmartPhrase

resident education

PDSA cycles

discharge planning

Admission A1C

Hemoglobin A1c Test Ordering

Hospitalized Patients with Diabetes

Hyperglycemia

Root Cause Analysis