Diabetes Electronic Prompt for Improved Care Coordination and Treatment in the ED

Summary

The goal of this clinical trial is to improve the processes of Type 2 Diabetes (T2D) care coordination and treatment in the emergency department (ED) by utilizing clinical decision support mechanisms in the electronic health record (EHR). The main question is whether electronic prompts triggered by hyperglycemia and elevated A1c results in providers providing earlier treatments and faster time to subsequent primary care appointment and greater reduction in hemoglobin A1c (HA1c). ED clinicians will receive alerts called Our Practice Advisories (OPA's) through the EPIC EHR. The 1st OPA triggers when a random point-of-care (POC) glucose is ≥250 mg/dL, prompting a suggested additional HA1c order. A 2nd OPA triggers if the resulting HA1c is ≥10%, prompting consideration of further care coordination in the Observation Unit. Investigators will compare the outcomes post-intervention compared to pre-intervention.

Eligibility

Inclusion Criteria:

Moderate hyperglycemia, (glucose ≥250 mg/dL)

* Patients who arrive in the emergency department
* Not pregnant or peri-partum
* Not SARS-COV-2 PCR positive in past 7 days

Exclusion Criteria:

* Diabetic ketoacidosis (pH \< 7.20, HCO3 \< 15, AG \> 25)
* Diabetic foot ulcer or skin complications
* Hyperglycemic hyperosmolar state with neurologic impairment
* Patients who leave against medical advice (AMA), elope from the ED, or are transferred to another facility

Conditions5

Locations1 site

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