An electronic protocol for translation of research results to clinical practice: a preliminary report

Abstract

Introduction: We evaluated the feasibility of using an electronic protocol developed for research use (Research-eProtocol-insulin) for blood glucose management in usual intensive care unit clinical practice.

Methods: We implemented the rules of Research-eProtocol-insulin in the electronic medical record of the Intermountain Healthcare hospital system (Clinical-eProtocol-insulin) for use in usual clinical practice. We evaluated the performance of Clinical-eProtocol-insulin rules in the intensive care units of seven Intermountain Healthcare hospitals and compared this performance with the performance of Research-eProtocol-insulin at the LDS Hospital Shock/Trauma/Respiratory Intensive Care Unit.

Results: Clinician (nurse or physician) compliance with computerized protocol recommendations was 95% (of 21,325 recommendations) with Research-eProtocol-insulin and 92% (of 109,458 recommendations) with Clinical-eProtocol-insulin. The blood glucose distribution in clinical practice (Clinical-eProtocol-insulin) was similar to the research use distribution (Research-eProtocol-insulin); however, the mean values (119 mg/dl vs 113 mg/dl) were statistically different (P = 0.0001). Hypoglycemia rates in the research and practice settings did not differ: the percentage of measurements < or =40 mg/dl (0.11% vs 0.1%, P = 0.65) and the percentage of patients with at least one blood glucose < or =40 mg/dl (4.2% vs 3%, P = 0.23) were not statistically significantly different.

Conclusion: Our electronic blood glucose protocol enabled translation of a research decision-support tool (Research-eProtocol-insulin) to usual clinical practice (Clinical-eProtocol-insulin).

Keywords: clinical; clinical protocol; computer protocol; glucose; intensive care; replicability.

Figure 1.

Single bedside Research-eProtocol-insulin computer screen. 1. Patient name and blood glucose protocol target range. 2. Data entry fields. 3. Get eProtocol-insulin recommendation button (new intravenous insulin infusion rate). 4. New insulin infusion rate recommendation with Accept or Decline checkboxes to the left (white background becomes gray after bedside clinician accepts or declines the recommendation). 5. Countdown timer displays 1 hour 59 minutes and 58 seconds to the next eProtocol-insulin-recommended blood glucose measurement (at 11:00 hours—displayed in the Next assessment window below the countdown timer). 6. Previous patient data with dates and times (this can be toggled to a graphical display with the Graph button above and to the right of the table).

Figure 2.

Distribution of percent (%) of blood sugar measurements during usual clinical care use of eProtocol-insulin in 13 intensive care units of seven intermountain Healthcare Hospitals (+) and in the LDS Hospital Shock/Trauma/Respiratory Intensive Care Unit (•), the eProtocol-insulin research development site.