Table of Contents Author Guidelines Submit a Manuscript
Anesthesiology Research and Practice
Volume 2011, Article ID 565069, 10 pages
Clinical Study

Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

1Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 4-44, Boston, MA 02114, USA
2Division of Neonatology, Department of Pediatrics, Texas Tech University Health Sciences Center, 701 West 5th Street, Odessa, TX 79765, USA
3Division of Neonatology, Department of Pediatrics, Johns Hopkins Medicine, 600 North Wolfe Street, Nelson 2-133, Baltimore, MD 21287-3200, USA
4Department of Anesthesiology, West Haven Veterans Affairs Medical Center, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT 06520-8051, USA
5Department of Anesthesia, Medical University of South Carolina (MUSC), 25 Courtenay Drive, Suite 4200, MSC 240, Charleston, SC 29425-2400, USA
6Department of Surgery, Johns Hopkins Medicine, 600 North Wolfe Street, Blalock 655, Baltimore, MD 21287, USA
7Cardiac Surgical ICU, Department of Nursing, Johns Hopkins Medicine, 600 N. Wolfe Street, Halsted 600, Baltimore, MD 21287, USA
8Director Lean Sigma Program, Center for Innovation in Quality Patient Care, Johns Hopkins Medicine, 601 North Caroline Street, Suite 2080, Baltimore, MD 21287-0765, USA

Received 15 April 2011; Accepted 22 June 2011

Academic Editor: Alparslan Turan

Copyright © 2011 Elizabeth A. Martinez et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.