1. Chart Review Duplicate testing of Hemoglobin A1c in patients admitted to UCI under medicine team D Samantha Harris UCI Internal Medicine Residency October 4 th, 2012

2. Methods Goal: To promote high-value, cost-conscious care within our residency program by avoiding unnecessary repeat laboratory testing Method: Reviewed all patients currently admitted to medicine team D in the inpatient setting at UC Irvine Medical Center Examined hemoglobin A1c values checked both during and prior to admission in 15 patients to see if A1c values checked were appropriate vs. inappropriate

3. Patient Population Reviewed 15 patients admitted to UCI in February under primary care of internal medicine, team D Of the 15 patients surveyed, reasons for admission included congestive heart failure, cellulitis, pneumonia, urinary obstruction, diabetic ketoacidosis, sepsis, shortness of breath, vomiting, vertigo, altered mental status, syncope, and seizure 11 men and 4 women, aged 21-83

4. Results of Hemoglobin A1c Testing Of the 15 patients: 4 HbA1cs were sent during the current admission 2 HbA1cs were sent within 3 months prior to admission Appropriate vs Inappropriate HbA1c assessed in table 1 Appropriate: Known hx of diabetes with no A1c in past 3 months Suspected diabetes with IFG or symptoms and no A1c in past 3 months Inappropriate No hx of diabetes, normal fasting glucose levels, asymptomatic Hx of diabetes or IFG with A1c within past 3 months

5. Table 1 – Analysis of patients with HbA1c checked either prior to or during hospitalization PatientPertinent History A1c / date performed Appropriate vs. Inappropriate 1) History of diabetes, presented with cellulitis 8.3% 1/23/12 Appropriate Did not recheck during hospitalization 2) No history of diabetes, presented with SOB from COPD 6.0% 2/1/12 ? Ordered by Gottschalk PCP Did not recheck during hospitalization 3) Admitted for DKA, and sepsis from pyelonephritis 14.7% 2/14/12 Appropriate No prior A1c on file, no prior admission. 4) Admitted for PNA, AMS and meningitis, with impaired fasting glucose levels 110-180 6.2% 2/12/12 Appropriate 5) History of diabetes, admitted with AMS from metastatic cancer 7.6% 2/12/12 Appropriate No prior A1c on file, Starting steroids. 6) History of diabetes, hyperglycemia, admitted for AMS 9.4% 2/15/12 Appropriate No prior A1c of file.

6. Conclusions All of the HbA1cs checked during admission appeared to be appropriate More should have been done? Of the 9 patients who had no A1C performed: 7 patients had no hx of diabetes or IFG (appropriate) 1 patient had diabetes with ESRD 1 patient had IFG (levels 116-127), with significant cardiac history Confounders: Unsure about outside PCPs or records May be attending-dependent Small sample population In setting of infections may not be accurate (both IFG and A1c) Did it really change management as an inpatient? How was it utilized as an outpatient?