Case Study Review: How Concord Hospital Leveraged Cpoe To Improve Diabetes Care Processes

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Case Study Review: How Concord Hospital Leveraged CPOE to Improve Diabetes Care Processes

Because of concerns about the quality of inpatient diabetes care, Concord Hospital in Concord, Massachusetts challenged its Chief Medical Information Officer, Joel Berman, M.D., to improve patient care and discourage the use of free-standing sliding scale insulin. 

Although he knew it would take research and creativity, Dr. Bergman decided to see if Horizon Expert Ordersâ„¢, a Computerized Physician Order Entry (CPOE) solution already being used to reduce medical errors at Concord, could also reduce inpatient diabetes care errors.

The challenge was to find a way to use CPOE to improve outcomes in more complicated diabetes cases, where decisions are made based many multidisciplinary factors.

Step 1 was to understand exactly what factors contributed and how to Concord's inpatient diabetes care problems. Focus groups identified four contributing factors:

The hospital's on-demand food program made it difficult for nurses to administer meal insulin at the right time

Nurses were confused about ...
... protocols due to the lack of consensus on diabetes care management

Glucose values were often unavailable to staff due to delays in glucometer docking

Physicians frequently forgot to adjust daily basal insulin doses

After identifying the contributing factors, the team comprehensively reviewed hospital workflow, looking for ways to streamline processes and incorporate CPOE technology into process management. 

Bergman's team created new CPOE alerts, for example, to notify the dietary center when a patient was carb counting, improving communication. After the overall diabetes care workflow had been reviewed, specific care processes were adjusted one at a time, so the team could tell when changes were making a difference.

To improve workflow, the staff started from where authorities agree on what the gaps are in diabetes care management. The team created an interactive, web-based form within Horizon Expert Orders to guide providers through insulin orders as a three-component bundle of basal, meal and correction doses, so the doses would more closely resemble normal pancreatic functioning. The form makes it easier to order the preferred protocol, and reminds them if a component is missed.

After completing the diabetes care management improvement initiative, Concord Hospital achieved the following results:

Obtained 80% Physician Satisfaction with the Horizon Expert Orders interactive form

All nursing staff received standardized training and passed a competency exam

Glucometer docking delays were reduced by more than half

Use of basal and prandial insulin increased 70% and 90%

Read the complete version of this CPOE case study, or learn more about the Horizon Expert Orders Computerized Physician Order Entry (CPOE) solution by visiting McKesson.