It’s been a year since Temple Health began its rollout of a new predictive tool for diabetes management, EndoTool Sub-Q (SQ)—and the results have been transformative.
EndoTool SQ, which is integrated into Temple Health’s electronic medical records system, uses algorithms to model, predict, and adjust insulin dosing for each patient. It calculates how much insulin a patient needs based on their weight, diet, diagnosis, kidney function, and history, with daily adjustments to improve insulin response.
This individualized approach, which delivers more accurate and effective care, has revolutionized diabetes management across Temple Health. It has significantly improved glycemic control metrics on all campuses, especially around hypoglycemia, and enhanced care teams’ ability to maintain patients within target glucose ranges.
Benjamin Slovis, MD, Temple University Hospital’s Chief Medical Information Officer, who played a key role in the implementation process, reflects on EndoTool SQ’s impact on care outcomes and how it speaks to Temple Health’s use of leading-edge technologies.
Temple Health: In the early stages of the rollout, you were seeing saw a 2-3x reduction in hypoglycemia across patient populations on EndoTool SQ, which was an overwhelming improvement. Is that still the case?
Dr. Slovis: At this point, we’re seeing persistent reductions in hypoglycemia rates up to 3x across Temple Health. That means a 3x reduction in hypoglycemia with EndoTool SQ and IV, and a 2-3x reduction on floors using EndoTool SQ.
That’s incredible, because avoiding hypoglycemia is our most important goal. If a patient’s glucose, or blood sugar, level, drops under 40, it can cause long-term damage and even death. By reducing hypoglycemia so dramatically, EndoTool SQ has significantly enhanced patient safety.
TH: What is it about EndoTool SQ that makes it so effective?
Dr. Slovis: Historically—and at many hospitals, to this day—you would use a sliding scale to figure out appropriate insulin dosing based on finger stick results. But EndoTool uses highly advanced predictive models to determine how much insulin each patient needs.
It takes into account their diabetes type, weight, recent creatinine levels, recent A1C and glucose levels, and additional elements of their basic metabolic panels. If they’re on EndoTool IV, which we use in our Emergency Departments and ICUs, it also considers their potassium levels.
Then, it will continuously adjust that dosing level over time to meet each patient’s needs, rather than deliver a one-size-fits-all standard. It makes insulin management much more individual—and effective.
TH: How many other health systems use EndoTool?
Dr. Slovis: We were actually the first health system that uses the Epic electronic medical record system to go live with EndoTool SQ, and we’re still the largest. Temple Health is leading the way in using the latest technology to provide patients with exceptional, and personalized, diabetes care.
We’re also the only health system that has fully integrated EndoTool within Epic. At other hospitals, you have to leave Epic to visit EndoTool, but we were able to streamline EndoTool access for our providers and extensively integrate it for our nurses.
TH: Why has Temple Health’s EndoTool implementation been so successful?
Dr. Slovis: Executive leadership was critical, including our CEO, CMO, CIO, and CNO, as well as Nursing leadership, our clinical informatics teams, and Dietary staff. The project was led by Senior Clinical Performance Excellence Manager Joy Weaver, DNP, MSN, RN. The leadership of David Fleece, MD, who ran the project in its early stages, was especially essential.
We’ve also had tremendous buy-in from our care teams, especially from Nursing. That’s because this was a very data-driven process, and you couldn’t argue with the results. We saw massive improvements in patient outcomes at each hospital, and when we showed those results to the next campus, they immediately understood why using EndoTool was so important.
By the time we got to Temple Health-Chestnut Hill Hospital, which was the last campus on our implementation list, our care teams had already heard so many good things about EndoTool that we reached 70% utilization by day two of the rollout.
TH: How can you continue to build on that success?
Dr. Slovis: Now that we’re excelling at maintaining patients’ glucose levels in our hospitals, we’re thinking more about what their insulin care looks like when they leave. Patients will be admitted on a certain insulin dose, but EndoTool will help us determine that they have a higher insulin requirement, and we want to make sure they stay on the dose they actually need.
This is an opportunity for collaboration between our inpatient and outpatient and primary care physicians and endocrinologists. It’s all about how we can safely transition these patients onto appropriate therapies when they’re discharged, and how we can get them an appointment with their PCPs or an endocrinologist as soon as possible so they can maintain the glucose control they had as inpatients and prevent another hospital admission. Our clinical and operations teams have had these discussions, and I look forward to strategizing with them on next steps.
TH: How does the EndoTool SQ implementation speak to the ways Temple Health is using leading-edge technology to enhance patient care?
Dr. Slovis: At Temple, we don’t go chasing shiny objects. We leverage new technologies when they meet a need. In this case, we identified an opportunity for enhancing glucose control, implemented a tool that performed far better than the status quo, and produced exceptional results for our patients.
That’s a key takeaway: you should be looking for opportunities where the status quo is not efficient, because those are the places to apply technological solutions. There are so many tools out there, but they’re only as good as the workflows they fit into. And if you go searching for shiny objects, or solutions to problems that aren’t there, you aren’t going to be focusing on what’s most important, which is serving patients.