Background:  Successful inpatient glycemic control programs achieve both improved glycemic control and low rates of hypoglycemia.  Using results from the analysis of performance in glycemic control and hypoglycemia, we identified top performers and those demonstrating the most improvement.   We sought to describe their key characteristics. 

Methods :  Participating hospitals (84 for ICU, 94 for non-ICUs) submit blood glucose data to the Society of Hospital Medicine (SHM) glucometrics reporting and benchmarking center, allowing for identification of nine hospitals with top quartile performance for a variety of glycemic control and hypoglycemia parameters (Figure) in the first half of 2014. A group of 5 physicians with experience in mentoring quality improvement and inpatient glycemic control developed survey questions and a complimentary structured interview administered to top performing sites in the Fall of 2014.  Multidisciplinary representatives from each institution participated.

Results :  Best practices were identified in 5 areas: Personnel, Support, Tools, Approach and Policies, and Barriers to Success.  All teams had a committed champion but their background and training varied (nurse, pharmacist, hospitalist, and endocrinology). 8/9 teams shared having C suite support initially and a multidisciplinary team.    All programs had established protocols and order sets with clear dosing guidance and 7/9 required their use.   They all used glycemic control data on a regular basis as well as a real-time system for tracking outliers and intervening.  Barriers to success identified were provider education and 6/9 specifically noted that the education of providers is accomplished in a case by case basis generally simultaneous with real time interventions.   Additional themes that were considered important but more challenging to quantify were 1. Celebrating small wins and being patient with progress 2. Approaching education of each set of providers in a supportive and flexible way to encourage communication about barriers. 

Conclusions: Although safe inpatient glycemic control remains a challenge.  Top performers in the SHM glucometrics database had a highly functioning multidisciplinary team, a program champion, standardized protocols, routine use of data and real-time interventions coupled with 1 on 1 provider education.