PURPOSE: A TISP was launched in 2004 to improve quality of care in rural hospitals. GC was a priority because it has been shown to improve morbidity, mortality, and ICU length of stay. We describe the impact on GC after initiation of TISP.
METHODS: Ten rural hospitals are linked by the TISP. The flagship hospital provides the staff of ten intensive care physicians and fifteen nurses who provide 24-hour supervision of 61 beds in hospitals separated by as much as 350 miles with populations to as low as 1,000. The GC protocol was based on the consensus of the Society of Clinical Endocrinology. Insulin administration is begun when glucose reaches 120 mg/dL to achieve a goal of 70-110 mg/dL. Human regular insulin is administered with three levels of aggressiveness depending upon the intensivist’s judgment. Modifications occur daily during remote “glucose rounds.” If glucose levels are not at goal and the patient is on the highest level of insulin administration, insulin glargine is added to the current sliding scale at an amount equal to 80% of the daily human regular insulin requirement and the sliding scale is lowered 1 tier. If glucose levels are greater than 150 mg/dL or there is wide variability, an insulin drip protocol is begun.
RESULTS: Average daily glucose levels fell from 144 mg/dL in the flagship hospital to 124 mg/dL. In the more remote hospitals, average daily glucose levels were reduced from 161 mg/dL to 139 mg/dL.
CONCLUSION: Improved GC in seriously ill patients was achieved by the introduction of the TISP.
CLINICAL IMPLICATIONS: Improved best practices outcomes can be seen in seriously ill patients in rural hospitals by a TISP.
DISCLOSURE: Edward Zawada Jr, None.