227 - Improving Resident Inpatient Diabetes Management and Resident Diabetes Education: A Quality Improvement Initiative

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 227
Publication Number: 227.45

Madeline F.E.. Parr, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Hackensack, NJ, United States; Catherine L. Hahn, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Westwood, NJ, United States; Gina Marino, Joseph M. Sanzari Children's Hospital, Hackensack, NJ, United States; Gabriella m. Sierp, Hackensack Meridian School of Medicine, marlboro, NJ, United States; Jessica Kaiser, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Verona, NJ, United States; Alaa Hussain, Hackensack Meridian School of Medicine, North Caldwell, NJ, United States; Steven Ghanny, Hackensack Meridian School of Medicine, Wayne, NJ, United States; Shoshana Tell, Hackensack University Medical Center, Paramus, NJ, United States

Presenting Author(s)

Madeline F.E Parr, MD

Categorical Pediatric Resident
Joseph M. Sanzari Children's Hospital Hackensack University Medical Center
Hackensack, New Jersey, United States

Background: Type 1 diabetes affects 1 in 300 youth. With a growing national shortage of pediatric endocrinologists, pediatricians require a foundational knowledge of diabetes management. Historically at our institution, inpatient diabetes care was primarily managed by a diabetes attending physician and the patient’s registered nurse (RN), with minimal resident involvement, and residents expressed discomfort with glycemic management.

Objective: We sought to initiate resident-led management to improve future pediatrician care of patients with diabetes. Our project aims were to improve resident engagement, education, and comfort with the management of diabetes.

Design/Methods: This quality improvement initiative used the Plan-Do-Study-Act (PDSA) cycle model. Key stakeholders were engaged. Process measures included the percentage of attending pages from residents vs. RNs and whether RNs first called attendings or residents with patient questions. Outcome measures included assessments of resident diabetes knowledge and comfort with management. Interventions for this first PDSA cycle included the creation and wide dissemination of a diabetes “tip sheet,” as well as revamping diabetes resident teaching sessions to focus on clinical cases, practical management, and diabetes technologies. Structured daily diabetes rounds were initiated, and RNs were encouraged to call residents first with clinical questions. Statistical analysis was performed using McNemar’s and paired t-tests in Python.

Results:
Resident comfort increased for management of hypoglycemia (37% to 72%, p< 0.05), ketones (11% to 44%), hyperglycemia (16% to 61%, p< 0.05), new-onset type 2 diabetes (16% to 44%), reviewing pump settings (0% to 28%) and calculating mealtime insulin doses (5% to 56%, p< 0.05). Scores on resident diabetes knowledge assessment increased from 58% to 76%. The percentage of direct attending pages from RNs decreased from 71% to 30%. By the end of the 1st PDSA cycle, 86% of RNs reported reaching out to the resident first with questions, although 14% of RNs reported being subsequently asked by the resident to call the diabetes attending directly.

Conclusion(s): This quality improvement initiative has improved resident knowledge of diabetes, comfort with inpatient management, and engagement. Future PDSA cycles will further familiarize residents with insulin pump functionalities, ensure the RNs utilize residents as their first point of contact, and streamline diabetes order sets to promote additional resident engagement.