Use of Endocrine Consultation for Hemoglobin A1C ≥9.0% as a Standardized Practice in an Emergency Department Observation Unit
| Autor: | Rifka Schulman-Rosenbaum, Donna Jornsay, Allison Tiberio, Robert Silverman, Elissa Wolff, Frederick Davis, Nina Hadzibabic, Dana Gottlieb, Katherine Cuan |
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| Rok vydání: | 2021 |
| Předmět: |
Glycated Hemoglobin
medicine.medical_specialty business.industry Endocrinology Diabetes and Metabolism General Medicine Emergency department After discharge medicine.disease Endocrinology Clinical Observation Units Diabetes mellitus Internal medicine Diabetes Mellitus medicine Cost analysis Humans Endocrine system Hemoglobin Medical prescription Emergency Service Hospital business Referral and Consultation Observation unit |
| Zdroj: | Endocrine Practice. 27:1133-1138 |
| ISSN: | 1530-891X |
| Popis: | Objective Severely uncontrolled diabetes mellitus (DM) is associated with poor long-term outcomes and may remain unrecognized. A high frequency of uncontrolled DM has been identified in the acute-care setting, including the emergency department observation unit (EDOU). We assess the use of standardized endocrine consultation in the EDOU for hemoglobin A1C (HbA1C) levels ≥9%. Methods Standard practice in our EDOU includes universal HbA1C screening and endocrine consultation for HbA1C levels ≥9.0%. As part of a quality improvement program, EDOU patients with HbA1C levels ≥9.0% had an endocrinology consult. One-month follow-up phone calls assessed the effects of consultation after discharge. Results HbA1C tests were administered to 3688 (95.7%) of 3853 EDOU patients, of which 7.0% (n = 258) were found to have an HbA1C level ≥9% (mean ± SD, 11.7 ± 1.8%; range, 9%-16.6%). Endocrine consults were completed for 73.6% (190/258) patients with severely uncontrolled DM. Among the 190 patients, 92.1% (n = 175) had discharge DM medication adjustments. For known patients with DM (n = 142), injectable diabetes medication prescriptions increased from 47.2% (67/142) on EDOU arrival to 78.2% (111/142) upon discharge. Newly diagnosed DM injectable prescriptions increased from 0% (0/48) on arrival to 72.9% (35/48) upon discharge. A total of 72.6% (n = 138) were contacted at a 1-month follow-up and 94.9% (n = 131) reported taking DM medications, compared with 68.2% (n = 94) before consult. Conclusion HbA1C screening coupled with endocrine consultation for HbA1C levels ≥9.0% was assessed as a performance improvement study and is shown to have valuable results. Further investigation is required to determine the long-term clinical impact and cost analysis for this novel approach. |
| Databáze: | OpenAIRE |
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