HgbA1c 18.2 - Insulin Initiation - Avg LOS?

[DaisyRN, ACNP]

I am working on a paper and trying to evoke the idea that it is not appropriate to start a patient on insulin and discharge them home the same day from the hospital.

Here's the situation:

I am with a hospitalist group right now (as an ACNP student) and we were consulted on a surgical patient (bilateral orchiectomies r/t CA) with poorly controlled DMII. His HgbA1c came back 18.2, so obviously, his current regimen is not working. We initiated 70/30 and the MD was planning on discharging him home later that same day. As I'm still a student, I don't have much say, yet, but we ended up being able to keep him an additional day because the surgeon agreed.

Research doesnt really give me any comparison on avg LOS for insulin teaching in the hospital, and I have failed to successfully manipulate the CMS website to find the information. I have found, however, that there are certain tasks/knowledge a patient with DMII must comprehend prior to discharge from the hospital, including the "7 Survival Skills." If I can't get any numbers, I'll just base the paper on the idea that you cannot properly assess effectiveness of insulin and ensure competency of the patient within the same date of initiation.

FYI: This particular patient is a 75 yr old Spanish-speaking only patient, that had "never" been taught proper nutrition or DM management, per his report. Case mgmt was getting his Medicare set up because he had never applied for it (or however you go about getting it). We were also working to set him up with outpatient diabetes education and home health.

Why did I post this problem here? I was thinking those of you with your extensive Medicare expertise would know the avg LOS covered for a 75 yo patient admitted with a secondary diagnosis of Uncontrolled DMII, and initiation of insulin that he is to continue using at home. He lives alone, but has a positive support system and I believe a family member would be able to learn how to help manage his DMII.

Thanks!!

[DaisyRN, ACNP]

NO one has any input on this?? I'm shocked... Or maybe its because there isnt an average LOS? I know that I read somewhere that an avg LOS for a primary diagnosis of DMII is 5 days... but that doesnt really address my topic. I'll try to figure something out, but if you guys do think of something, anything, let me know. :)

Thanks!

[areeve01]

The average LOS I would authorize at my health plan would vary dependant upon many factors. If they require an insulin drip, that usually lengthens the LOS, as they wean off the drip onto ssc/scheduled insulin.

Many require 3-5 days total to tweak the insulin doses, but we don't use a set LOS for this. We review based on medical necessity evaluated by endocrine stability. Not much help for your paper! But there is a resource that lists the LOS based on DRG payment. You could probably google it to find it electonically.