Evaluating inpatient glycemic management: the Quality Hyperglycemia Score.

BACKGROUND

Inpatient hyperglycemia has become a major focus at many hospitals. However, although several professional organizations have pushed for improved inpatient glucose management, glycemic control at many institutions remains suboptimal. There is a general consensus that improved quality of care is needed, but objective assessment of care quality remains a challenge. Lack of clear, effective performance feedback to clinicians is one element that may derail efforts to improve practice.

METHODS

We developed a simplified grading system, the Quality Hyperglycemia Score (QHS), to allow clinicians and managers to easily review and compare glycemic management on adult medical-surgical and intensive care units over the prior 3 months and to more fully engage patient care teams in quality improvement.

RESULTS

The QHS represents a single value from 0 to 100, incorporating elements of glycemic management influenced by all team members. The scoring system rewards the maintenance of blood glucose levels in or near the normal range and adherence to the hospital policy on the use of bedside glucose meters, but penalizes frequent hypoglycemic episodes and severe hyperglycemic excursions. Each element is weighted independently and summed to produce the QHS. Scores then correspond to a color code highlighting each unit's performance level.

CONCLUSIONS

To date, the QHS reflects the spectrum of blood glucose management at our hospital. While refinement and internal and external validation with clinical outcomes are planned, we propose the QHS as a standardized, objective measure of the quality of inpatient glycemic management.