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

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

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.

Type 2 Diabetes (T2D) is a growing public health crisis with rates of diabetes steadily increasing over the last 10 years. The ED is commonly the first point of contact for individuals who present with symptoms of hyperglycemia, often with very severe (HbA1C > 10%) underlying diabetes. However, there is currently no national guideline or clinical policy for the ED management of patients who are not in diabetic ketoacidosis (DKA) or in a hyperglycemia hyperosmolar state (HHS). The investigators hypothesize that there are two subgroups who may benefit from greater care coordination initiated from the ED: patients who are newly-diagnosed with severe T2D and patients whom T2D is poorly-controlled despite medication adherence. This study designs electronic prompt practice advisories that nudge ED providers towards more aggressive treatment pathways. It is currently unknown whether alert tools can improve the delivery and coordination of care of patients with severe T2D presenting to the ED.

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