Applying quality improvement methods in a hyperbaric oxygen program: Reducing unnecessary glucose testing

Sarah L. Stevens, Atsushi Sorita, Anthony J. Narr, Paul L. Claus, Ann Tescher, Martha P. Millman, Raymond C. Shields, William G. Buchta, Robert Haddon, M. Hassan Murad

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: To describe the implementation of a quality improvement (QI) project that aimed at improving and standardizing glucose checks on patients with diabetes undergoing hyperbaric oxygen (HBO2) therapy. Methods: This is a prospective cohort study. Following the Model for Improvement, nurses and physicians ran several Plan-Do-Study-Act (PDSA) cycles over a four-month period, with multiple iteration and testing changes. They developed and implemented a nurse-led protocol that was tested prospectively. Results: Compared to the pre-protocol baseline (N = 332), glucose checks per session guided by the protocol decreased by 37.7% (2.84 vs. 1.77 per session, <0.001). Compliance with the new protocol was higher than compliance with the existing protocol (97.3% to 84.2%, <0.001). There were no cases of a symptomatic hypoglycemic event after the implementation of the protocol. Conclusions: A quality improvement project implemented by a multidisciplinary team in a hyperbaric practice was feasible and has improved the management of diabetic patients undergoing HBO2 therapy. Considering how the hyperbaric community values the culture of safety and considering the feasibility of this project, more QI training and projects in hyperbaric programs should be performed.

Original languageEnglish (US)
Pages (from-to)427-435
Number of pages9
JournalUndersea and Hyperbaric Medicine
Issue number4
StatePublished - Jul 1 2016


  • Diabetes
  • Glucose check
  • Hyperbaric oxygen

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Physiology (medical)


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