MON-875 - Quality Improvement to Standardize Inpatient Steroid-Induced Hyperglycemia Management through an EMR-Embedded Protocol and Advisory System

Steroid-induced hyperglycemia (SIHG) is common in hospitalized patients and is linked to infections, impaired wound healing, poor perioperative outcomes, and increased length of stay and healthcare costs, yet screening and management remain inconsistent.

We administered an anonymous survey to inpatient prescribers at a community hospital to assess SIHG knowledge, current practices, and barriers. A total of forty-three prescribers responded: internal medicine residents 69.7%, hospitalists 16.3%, family medicine residents 11.6%, and mid-level providers 2.3%. Steroid prescribing was common (44.2% >1 time/week; 46.5% >1 time/month). Although most respondents agreed SIHG contributes to adverse inpatient outcomes, 32.8% reported that only screened for SIHG sometimes, rarely or never. Reported barriers to SIHG management included lack of a clear protocol (58.1%), concern for hypoglycemia (18.6%), uncertainty about differences in SIHG management for diabetic versus non-diabetic patients (16.3%), and time constraints (7.0%). A tailored SIHG protocol was viewed as beneficial by 72% of respondents.

To address the need for a formal SIHG management guide, we conducted a targeted literature review and developed an evidence-based and practical SIHG protocol for early diagnosis and management. The protocol recommended an insulin regimen determined by steroid pharmacokinetics (short-, intermediate-, and long-acting) and included dose-adjustment guidance based on glucose trends, renal function, age, and steroid taper/discontinuation. Recommendations specified insulin type, starting dose, and route for both insulin-naive patients and those already using insulin.

To facilitate availability at the point of care, the protocol was embedded into the electronic medical record (EMR) system and an “Our Practice Advisory” (OPA) displayed when a patient receiving systemic corticosteroids had a blood glucose >180 mg/dL and no insulin orders. The OPA recommended increasing glucose monitoring frequency or initiating insulin and provided a direct link to the protocol. In the setting of steroid discontinuation, a second advisory prompted reassessment and de-escalation/discontinuation of insulin to reduce hypoglycemia risk. Educational sessions were conducted to familiarize physicians and nursing staff with the protocol and OPA.

Baseline data revealed actionable gaps in SIHG screening and protocol availability. An EMR-embedded protocol plus automated advisories targets key barriers and provides scalable decision support; pre/post-intervention evaluation of screening rates, insulin initiation, glycemic outcomes, hypoglycemia, and length of stay is underway.

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