Another Success Story: Crossings’ Insulin Management Advisors
In a critical care setting, management of patients’ hyperglycemic states can pose challenges for physicians. In response, Crossings Healthcare Solutions created four Insulin Management Advisors for complicated conditions using the Cerner® MPage platform: Diabetic Ketoacidosis, Hyperglycemic Hyperosmolar State, Critical Care Insulin and Post-Cardiac Surgery Insulin.
Marreddy Yeruva, MD, Assistant Chief Medical Information Officer at Universal Health Services (UHS), helped create the advisors. “Managing these syndromes is very complex,” he says. “It involves complicated mathematical calculations, placing several orders and managing the patients very closely during their hospital stay.”
That is why all four advisors feature built-in, real-time clinical decision support and evidence-based treatment recommendations to help standardize patient care and reduce variation.
Evidence-Based Practice Improves Patient Care
The Diabetic Ketoacidosis and Hyperglycemic Hypersmolar State Advisors are based on American Diabetic Association guidelines, while the Critical Care Insulin and Post-Cardiac Surgery Insulin Advisors are customized from clinical content from the Portland Diabetes Project. The advisors are implemented at all 26 UHS acute care facilities.
“We wanted to standardize evidence-based protocols across all hospitals, enable physicians to review the protocols and address them in very short period of time,” Dr. Yeruva explains. “This prevents multiple phone calls and patient micromanagement so that we can promote the guidelines.”
Crossings’ Insulin Management Advisors provide physicians with evidence-based recommendations that include IV fluid management, glucose correction, electrolyte replacement, acidosis and anion gap correction, and subcutaneous insulin transition. The advisors clearly benefit patient care by reducing complications and improving outcomes. “Even though these protocols are well studied and there is clear evidence on how to manage these patients, there is a lot of confusion among care providers on the appropriate care for these patients,” says Dr. Yeruva. “Being able to standardize protocols and provide timely advice to nurses minimizes some of these workflow variations and improves patient care.”
Recognized for a Stand-Out Solution
Crossings’ Insulin Management Advisors differ from other available solutions, and those differences are paying off. “Our advisors are integrated into Cerner, picking everything up in real time. Similar solutions rely on nursing to enter data into an external solution,” explains Carly Hahn, IS Supervisor at UHS and part of the advisor development team.
Dr. Yeruva adds: “Since the advisors are within the Cerner system, we have really robust reporting tools — real-time tracking of nursing workflows and real-time reporting.”
“I have seen comments from endocrinologists saying that it is the best tool they have ever seen,” Dr. Yeruva says. “Diabetic programs are commending us for giving them a tool that not only meets needs but exceeds expectations.”
Crossings was honored with the inaugural Intelligence Connect award for the Insulin Management Advisors at the 2015 Cerner Health Conference.