EARLIER DISCHARGE: Improved blood sugar checks help reduce heart patients’ hospital stay by a day.
OPEN heart surgery patients can now be discharged a day earlier, thanks to improved procedures introduced by a healthcare team at the National Heart Centre Singapore (NHCS).
The team at the centre’s Cardiothoracic Surgery Intensive Care Unit (CTSICU) found a more efficient way to control patients’ glucose levels, and this allows them to be discharged after six days instead of the previous seven.
Glucose levels are key to the success of surgery and recovery, and are tracked throughout the patient’s stay in hospital – from the operating theatre (OT) to the intensive care unit (ICU) and the wards.
“If you don’t track them frequently, a patient might become hypoglycaemic (when the level falls too low) and that can be life-threatening,” said Dr Tan Teing Ee, Senior Consultant, Department of Cardiothoracic Surgery, and Director, CTSICU, NHCS.
Tracking the levels
To improve patients’ glucose levels, the team introduced two protocols.
The first was initiating the continuous intravenous insulin infusion (CIII) for patients in the CTSICU immediately after open heart surgery.
This was to achieve the target of 4-8mmol/L. These are the blood sugar limits for critically ill patients, recommended by the American Diabetes Association (ADA). This has been practised since 2007.
Previously, levels were found to be acceptable while patients were in the OT and ICU, but not when they were sent to the wards
and started taking oral medication.
“By the time they arrived in the High Dependency Unit and started eating again, their blood sugar levels had become very high again,” said Dr Tan.
To tackle this, a second protocol was developed in 2009, to help doctors transit patients from the CIII in the CTSICU to preoperative diabetes therapy in the general wards after heart surgery.
The target was to achieve a level of less than 10mmol/L (the blood sugar limit for non-critically ill patients, recommended by the ADA).
By using these protocols, the team evaluated 120 patients and found a 3.5-fold increase in those who had blood sugar levels within the ADA’s desired range.
“We found, with the protocols in place, 70 per cent of our patients achieved optimal blood sugar levels,” said Ms Dahliana Idris, Advanced Practice Nurse (Intern), Nursing Development Unit, NHCS.
“These controls are needed, because high blood sugar levels can reduce a patient’s resistance to infection and affect their heart function,” said Ms Cing Suan Lian, Senior Staff Nurse (Clinical), CTSICU, NHCS.
Mr Ismail Sheriff, Senior Nurse Manager, CTSICU, said nurses have a crucial role in managing patients’ blood sugar levels.
“To optimise outcomes, we follow protocols strictly.”
The team’s other improvements to patient care include tilting beds to reduce the risk of lung infection and removing breathing tubes from patients four to six hours after operations, instead of the next morning.
“By removing it early, patients can leave the ICU the next morning, cutting down their stay there,” said Dr Tan.
The protocols were documented and won the Best Poster Award (Nursing Category) at the second SingHealth Duke-NUS Scientific Congress held recently.
• This story was first published in Singapore Health, Nov/Dec 2012.