Effect of Endocrinological Dashboard Implementation For the Instigation of Consult Engagement (EDIFICE) on Healthcare-associated Infection Incidence in Adult Inpatients

An electronic dashboard has been created for the purpose of this study which will be utilised by the endocrine department (consultants and registrars), and randomise patients into three separate arms of intervention. The dashboard will monitor the electronic medical records and randomly allocate patients who meet the following criteria: A single glucose reading above 20mmol/L in the last 24 hours, two glucose readings greater than 15mmol/L in the preceding 24 hours, a blood glucose reading less than 3.0mmol/L. The three arms of intervention are: 1. Control arm - No active input from the Endocrine service at that time. Standard care will be provided by the home team who will still be able to ask for consultation in keeping with their usual practice. 2. The endocrinology consult service will proactively instigate a bedside consult within 24 hours of enrolment in the study, aiming to optimise glycaemic control. Consulting service will involve endocrinology an consultant and registrar with documentation in the electronic medical record. 3. Virtual arm whereby generic advice is entered into the electronic medical records (EMR) and offer of titration is made to the home team within 24 hours of enrolment in the study. The entry will be made by the endocrinology registrar and will be as detailed below and monitored via the EMR: • This patient has been identified automatically as part of a clinic study aimed at early identification of in patient dysglycaemia (CALHN HREC No. 17529). • The following are recommended for patients with hyperglycaemia: - All patients with should have an HbA1c if not performed within the last 3 months - Blood glucose concentration should be measured 4-6 hourly whilst an inpatient (ideally pre-meals and pre-bed) - In general blood glucose target for admitted patients are 5-10 mmol/L but may require alteration based on patient specific factors - Regular medication should be charted in stable patient tolerating oral intake if clinically appropriate - If patients are consistently using supplemental insulin for >48hours consider introducing long acting insulin and prandial insulin as required - If is a new diagnosis of diabetes is made or new injectable diabetes medication has been started, a diabetes nurse educator consult should be sought as early in the admission as practical If required, the endocrine team can be contacted for formal consultation or remote assistance with insulin titration, this will not occur unless the home team make contact through the usual pathway.