Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

被引:19
作者
Martinez, Elizabeth A. [1 ]
Chavez-Valdez, Raul [2 ,3 ]
Holt, Natalie F. [4 ]
Grogan, Kelly L. [5 ]
Khalifeh, Katherine W. [6 ]
Slater, Tammy [7 ]
Winner, Laura E. [8 ]
Moyer, Jennifer [7 ]
Lehmann, Christoph U. [3 ]
机构
[1] Harvard Med Sch, Massachusetts Gen Hosp, Dept Anesthesia Crit Care & Pain Med, 55 Fruit St,GRB 4-44, Boston, MA 02114 USA
[2] Texas Tech Univ, Hlth Sci Ctr, Dept Pediat, Div Neonatol, Odessa, TX 79765 USA
[3] Johns Hopkins Med, Dept Pediat, Div Neonatol, Baltimore, MD 21287 USA
[4] Yale Univ, Sch Med, West Haven Vet Affairs Med Ctr, Dept Anesthesiol, New Haven, CT 06520 USA
[5] MUSC, Dept Anesthesia, Charleston, SC 29425 USA
[6] Johns Hopkins Med, Dept Surg, Baltimore, MD 21287 USA
[7] Johns Hopkins Med, Dept Nursing, Cardiac Surg ICU, Baltimore, MD 21287 USA
[8] Johns Hopkins Med, Ctr Innovat Qual Patient Care, Lean Sigma Program, Baltimore, MD 21287 USA
关键词
D O I
10.1155/2011/565069
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.
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页数:10
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