Following her successful heart valve surgery at Vanderbilt, Gwendolyn English and her family faced a long journey home to Florida. Her family was concerned about the trip, because English has diabetes and her blood sugar levels had been fluctuating erratically.
“We were really worried about the drive home. She could go unconscious or get very sick if her levels go too low,” said English’s daughter, Monique Roberts. “We wanted to know what we should look for and what we could do.”
Ann Hackett, MSN, an adult nurse practitioner, provided specialized diabetes care to English. She also came to English’s room daily and provided education materials and reassuring advice the family could use on the trip home. Hackett is part of a new Glucose Management Service (GMS), the latest in a recent trend of specialty and consult teams formed at Vanderbilt and led by nurse practitioners.
“We are well equipped to handle all levels of care, from patients with insulin pumps to those on dialysis or intravenous insulin. I might see patients like Ms. English three or four times a day both to monitor them and to adjust therapy,” Hackett said.
Increasingly at Vanderbilt, experienced advanced practice nurses are being hired to provide intensive attention to inpatients with multiple, complex health conditions. The goal is to increase quality, reduce length of stay and lower the risk of readmissions for patients who are among the sickest at Vanderbilt.
The current endocrinology consultation service, staffed by an attending physician and fellow, has expanded with the addition of two full-time and one part-time nurse practitioners. The hope is medical/surgical services with diabetes patients will make greater use of the service.
Along with the endocrinologists, the GMS nurse practitioners monitor patients closely, make adjustments to diabetes treatment, and provide seamless, quick transitions to outpatient clinics to improve outcomes for patients with diabetes.
Shubhada Jagasia, M.D., GMS director and associate professor of Medicine in the Division of Diabetes, Endocrinology, and Metabolism, said nurse practitioners play an important role for diabetes patients in the hospital because of a shortage of endocrinologists and the growing incidence of diabetes.
“Diabetes is a very prevalent medical problem in Tennessee. We may have as many as 200 or more patients on insulin therapy in our hospital every day, making this an important area to focus on. Improving blood glucose control can translate into an improvement in both short-term and long-term outcomes for these patients,” said Jagasia, who also serves as medical director of the Vanderbilt Eskind Diabetes Clinic.
Jeffrey Boord, M.D., MPH, assistant professor of Medicine and quality director for the Vanderbilt Heart and Vascular Institute, helped set the stage for the approval of the GMS when he performed a review of uncontrolled diabetes hospital patients, showing that only about 15 percent were evaluated by the endocrinology consult service. His subsequent pilot study showed that a GMS could make a significant difference in care.
“We showed that it was feasible to provide 100 percent reliability in modifying discharge diabetes therapy and discharge planning for hospital patients evaluated by a glucose management service,” Boord said.
The GMS team includes Hackett, James Mills, MSN, APRN, and Blake Salmony, MSN, APRN. In addition, Brett Kinzig, MSN, APRN, staffs the post-discharge diabetes clinic to provide transitions into outpatient care within one to two weeks after discharge.
“We are very excited to have the new nurse practitioner Glucose Management Service. We hope it will help to address diabetes-related issues early, reduce associated complications, length of stay, and will help our patients’ improve their health post discharge,” said April Kapu, MSN, R.N., assistant director of Advanced Practice Nursing for Vanderbilt University Hospital.
Clare Thomson-Smith, MSN, R.N., J.D., director of the Center for Advanced Practice Nursing and Allied Health, said the service is part of a trend toward advance practice nurses and physician assistants working in close collaboration with physicians and other members of the care team to provide personalized care for very complex patients.
“Integration of nurse practitioners as vital members of the health care team has become critically important in hospitals. When you take great care to recruit and train nurse practitioners and deploy them in roles where they are ideally suited, you improve access and efficient transitions through the continuum of care that improves outcomes and ultimately reduces costs,” Thomson-Smith said.
