Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 21


Thursday, Apr 25
1:00 PM – 1:30 PM

Objective :

Diabetes mellitus is common among hospitalized patients. The American Diabetes Association recommends performing a Hemoglobin A1C on all patients with diabetes admitted to the hospital if not performed in the prior 3 months. Less than 60% of healthcare providers check Hemoglobin A1C in hospitalized patients with diabetes. This may lead to the suboptimal care of patients living with diabetes.

Methods :

We analyzed the data of patients with a known history of diabetes admitted who were admitted to a 240-bed community hospital between January 2016 and August 2018. Observation patients were excluded from the analysis. Patients who had Hemoglobin A1C result available in the previous 3 months were excluded. We calculated the percent of patients with a history of diabetes who have their Hemoglobin A1C measured during the hospitalization. A team of an endocrinologist, pharmacist, hospitalist, administrator and Lean Six Sigma coach implemented hospital-wide awareness and marketing campaign and collaborated with Hospital’s leadership, laboratory, medical staff, pharmacists, medical and surgical unit managers, and nurses. Lean Six Sigma principles were utilized to define the goals and interventions.

Results :

8883 patients with diabetes (70.6 ± 0.2 years old) were admitted during the study period. At the baseline, only 59% of patients with a history of diabetes had their Hemoglobin A1c measured. After Lean Six Sigma interventions, the frequency of increased to 68% (p=0.0029).

Discussion :

High-quality hospital care for patients with diabetes requires both hospital care delivery standards and quality assurance standards for continuous process improvement. Lean and Lean Six Sigma in Healthcare. Lean Six Sigma applications in healthcare setting require an understanding of how the tools, stakeholders and methodologies translate to the people-intensive processes of patient care.

Conclusion :

Ongoing collaborative interventions may have increased the frequency of Hemoglobin A1C measurements among hospitalized patients with diabetes, which helped to tailor the diabetes care of study patients. Our team is planning to replicate this Lean Six Sigma process improvement methodology to create a more efficient and cost-effective care for patients with diabetes.


Mihail Zilbermint

Assistant Professor of Medicine, Chief and Director of Endocrinology, Diabetes and Metabolism at Suburban Hospital
Johns Hopkins Community Physicians, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine
Bethesda, Maryland

Dr. Mihail “Misha” Zilbermint is the Chief and Director of Endocrinology, Diabetes and Metabolism Care at Suburban Hospital, Johns Hopkins Medicine in Bethesda, MD. He established an Inpatient Diabetes Management Service, modeled after a similar initiative at the Johns Hopkins Hospital. His goal is to promote better glycemic control and reduce hypoglycemia in hospitalized patients at Suburban Hospital. Dr. Zilbermint is an Assistant Professor of Medicine at the Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine.

Lee Ann Alexander

Clinical Pharmacist
Suburban Hospital
Rockville, Maryland

I have been a clinical pharmacist for over 35 years with an interest in Diabetes and Geriatrics. I have an APhA certificate in Diabetes and am a Board Certified Geriatric Pharmacist. I am in charge of the Internal Medicine pharmacy program at Suburban Hospital and precept the Internal Medicine and Diabetes rotations to our PGY1 residents. I also serve as a member of our Glucose Steering Committee, Johns Hopkins Pharmacotherapy Specialty Panel and the JH Armstrong Institute Diabetes Clinical Community group. I am part of an interdisciplinary group which conducts diabetes teaching classes to patients, employees and the community.

Isha Misra

Johns Hopkins Community Physicians at Suburban Hospital


Iniuboho Akpandak

Program Administrator
Johns Hopkins Community Physicians at Suburban Hospital


Wilson Lamy

Senior Quality & Innovation Coach
Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine