Changing practice takes time and careful consideration. Morgan Jones, MD, assistant professor in the division of endocrinology and metabolism, led the development and implementation of specialized diabetes inpatient consultative services in collaboration with multiple hospital services and departments. What started as a VCAG (Value Care Action Group) project in 2018 has evolved to become the UNC Diabetes Management Service, working closely with UNC Medical Center’s Diabetes Oversight Committee. Assuming a data-driven approach to identifying problems and solutions, diabetes care teams are dramatically altering practice to ensure the safety of patient care while also reducing length of stay.
Insulin Order Set
To date, a variety of tools and educational resources have been developed to improve patient care. These include the Diabetes Care Team, Glucose Precautions and new LMS modules for nurses. Already, these projects have contributed to the successful reduction of hyperglycemia, and variability in hospitalized patients. UNC Health’s Care Redesign, which works in many areas to create clinical care pathways that improve patient outcomes and make it easier for providers to deliver the desired care, applauded the team’s efforts. They are bringing diabetes improvement system wide starting with an insulin order set.
“This has been a great team effort and has enabled all of us to better serve patients with diabetes,” said Jones. “It was because of our original VCAG support and improvement in at UNCMC that we are now able to move this work to the system level.”
Now, Jones and the team at UNC Medical Center is collaborating with UNC Rex through Care Redesign to complete this order set.
“We’d like for providers to be aware of the insulin order set, and to know that Care Redesign may reach out to ask for a provider evaluation. This will help us know what improvements might be needed for a successful system roll out.”
Risk Stratification Tool and Diabetes Dashboard
The insulin order set is only a piece of the proposed diabetes improvement. Jones’ current VCAG efforts are focusing on decreasing hypoglycemia after success with reducing hyperglycemia. Care Redesign remains active in this project as well. Currently, a computer model which is evidenced-based is being developed to predict hypoglycemia. This tool is expected to be a benefit for high risk patients for hypoglycemia and reduce overall hypoglycemia. Meanwhile, the recently developed Diabetes Dashboard designed to filter diabetes data across services and across hospitals will help providers monitor individual services and track patient progress.
“This is really a tool that is helping us strive for the highest levels of patient care. We think of the Diabetes Dashboard as a kind of accountability tool, that holds us accountable in our care for patients.”
Original Inpatient Consultative Service Now Serving More Hospital Specialties
Finally, the Diabetes Care Team has expanded to co-manage eight services. They include Urology, Ear Nose and Throat, Neurology, Thoracic Surgery, Cardiothoracic Surgery, Burn Surgery, Transplant Surgery and Heart Failure Medicine.
The consultative team consists of four advanced practice providers and four faculty physicians. APPs include April Goley, FNP, Bonnie Alexander, PA, Veronica Hudson, PA, and Avni Garg, PA-C. Physicians included Morgan Jones, MD, Josh Evron, MD, Donald Carracio, MD, and Stephen DeCherney, MD, MPH.
Value Care Action Group
This glucose management project started as one of many Value Care Action Group improvement efforts taken up by the UNC Department of Medicine. Ron Falk, MD, chair of the department created the group and appointed champions in each medicine division, encouraging the review of current practices that look for improvements for high-value outcomes in healthcare. High-value is defined by the quality of patient-centered care achieved per unit of cost. Scott Keller is the director of business development keeping the team focused on value-oriented care models. Darren DeWalt, MD, serves as medical director for the team and helps define the projects. John Vargas is the project manager.