Improving hospital care for patients with diabetes

Caring for patients with diabetes in the hospital can be challenging, Dr. Robert McCauley acknowledges.

Dr. Robert A. McCauley, chief of endocrinology at Lehigh Valley Health Network, says if hospitals want to improve care for patients with diabetes, it must be an organization-wide priority.

McCauley, MD, is the chief of endocrinology at Lehigh Valley Health Network in Pennsylvania. He says hospitals must closely monitor patients in the hospital with diabetes, even if the patient is in the hospital for a problem other than their diabetes.

“When patients come in, they're sick,” McCauley says. “They may not be eating as well. They may be getting medications that can cause higher blood sugars. And as they get better, things change. And diabetes is very dynamic, and so you can't start it and forget about it. You have to be on top of it, watching it.”

“I think that's probably one of the biggest challenges, always, to make sure that we are recognizing that diabetes is dynamic,” he explains. “We have to make sure we're addressing it, looking at the blood sugars, and making appropriate adjustments to the medication as we need.”

Lehigh Valley is one of the first health systems to gain recognition in a new program created by The American Diabetes Association and The Leapfrog Group. The program, which launched last year, honored 17 hospitals who are leaders in treating patients with diabetes. (Hospitals can apply for recognition in next year’s group of honorees; the deadline is Nov. 30.)

Two of Lehigh Valley’s hospitals were honored earlier this year: Lehigh Valley Hospital-Cedar Crest and Lehigh Valley Hospital-Muhlenberg.

“I think the team that's involved in the care for diabetes, which is with everyone in the hospital, takes pride in what we can do for our patients,” McCauley says. “So I think it was just a great honor and validation for the good work that we're doing, that we really try to put the patient first in terms of treating their diabetes.”

In an interview with Chief Healthcare Executive®, McCauley discusses the work Lehigh Valley has done to provide high-quality care for patients with diabetes, and offers suggestions for health systems who are looking to improve.

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The team approach

When asked for a key ingredient in Lehigh Valley’s success, McCauley pointed to the fact that it’s a priority across the organization.

“We really do try to have a team approach, and it's not just the doctors or just the nurses,” he says.

Meal servers, for example, will make sure to remind patients with diabetes that they have to get their blood sugar checked.

If a patient is going to have surgery and won’t be eating, medication will be adjusted, he notes. Similarly, if a patient in an intensive care unit is receiving steroids, “that’s going to affect their diabetes,” he says.

“Everyone needs to take ownership of it,” McCauley says. “Not to say they have to manage it, but be aware of their therapy if they have an impact on the control of the diabetes, and make sure appropriate people who would need to make adjustments to the medication are being informed about that. That's, I think, probably the biggest thing.”

Lehigh Valley’s nurses also play a critical role, reinforcing the need for patients to regularly check their blood sugar and helping to guide patients with what they need to do outside the hospital.

The health system also has developed a strong team of diabetes educators who work with patients, and with clinicians to be in tune with diabetes management, McCauley says.

“They're very invested in making sure we’re treating diabetes appropriately,” McCauley says. “We know how much diabetes affects so many other aspects of their health care in the hospital, that they want to make sure that they keep that as a forefront.”

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Reaching patients

Part of helping people with diabetes involves tackling some other social factors that are affecting their health more broadly.

McCauley acknowledges that it’s difficult.

“I wish I had the magic answer, because I don't think we do,” he says. “I think it's trying to get to each patient at their level and what we can offer them with our network.”

Lehigh Valley’s population health department will work with patients who may have transportation issues that make it more difficult to get to clinics. Lehigh Valley also offers telehealth appointments for patients that can’t easily get to an office for an appointment.

Lehigh Valley’s physicians will also go to clinics and offices serving more remote communities in northeastern Pennsylvania.

The system also tries to help patients with their diet.

“I think medicine is never one answer that fits everyone, and it's trying to find the right answer that fits for that person … really just sitting down, understanding where they're coming from and finding out, you know, what they're able to change, what they're willing to change, and then trying to come up with a plan together that works for them.”

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Making diabetes a priority

McCauley stresses the importance of the entire health system getting efforts to improve diabetes care. Hospitals that are aiming to do better for patients with diabetes need to make it a goal across the organization.

He also says it doesn’t necessarily require a substantial financial investment, but hospitals will need to spend time on diabetes care.

“They will need the time investment to get sure that they have the education to give to the providers and the nurses …and support from the senior leadership to make it a priority,” McCauley says.

“Unfortunately, there's so many different priorities out there that every system is looking at, unless it's a priority that is being monitored, being tracked, it's going to fall to the wayside, because there's going to be other priorities that's going to overtake it.”

Again, though, McCauley emphasizes the value of the team approach for hospitals in caring for patients with diabetes.

“Our successes were related to the teamwork, that we were all working together,” McCauley says. “It wasn't just the endocrinology team that was doing it. Really, it was a system-wide approach. And I think for any other hospital system that wants to do it, that's what they're going to want to embrace.”