When it comes to using technology to improve patient safety and outcomes, Temple Health is always leading the way. That’s why we’ve implemented a revolutionary new tool for diabetes management across our Health System: the EndoTool Sub-Q (SQ) predictive software system.
“EndoTool uses algorithms to model, predict, and adapt subcutaneous insulin dosing recommendations for each patient,” explains Ben Slovis, MD, Temple University Hospital’s Chief Medical Officer. “It calculates insulin doses based on patient weight, diet, diagnosis, renal function, and previous glucose responses, with daily adjustments to improve insulin response. This makes dosing much more accurate and allows for more individualized care.”
The results have been almost immediate—and astounding. “The glycemic control metrics across all our campuses have significantly improved, and our ability to maintain patients within the target glucose range has been tremendous,” says Chaudron Carter Short, PhD, EdD, MHA, MHEd, MSN, RN, NEA-BC, Temple Health’s Executive Vice President and Chief Nurse Executive.
In particular, we’ve reduced hypoglycemia—or low blood sugar—by 2-3x across our patient population. “This was one of our top priorities in introducing Endotool, because hypoglycemia can be so dangerous for patients,” says Dr. Slovis. “If your blood sugar gets too low, you can die. Anything below 70 is concerning, and anything below 40 is critical. This is such an encouraging result, and a sign that we’re making a real difference.”
Better glucose control also helps improve our patients’ post-procedure recovery outcomes. “Maintaining proper blood sugar after something like bypass surgery is crucial for ensuring patients don’t experience infections,” explains Ajaykumar D. Rao, MD, MMSc, FACP, Chief, Section of Endocrinology, Diabetes and Metabolism at the Lewis Katz School of Medicine at Temple University. “Effective diabetes management is a key part of even our highest-acuity care.”
Systematic Processes for Sustainable Improvement
Rolling out a new care management tool across such a large Health System is a major undertaking. “It requires significant effort to gain end-user buy-in and shift longstanding clinical behaviors,” explains Senior Clinical Performance Excellence Manager Joy Weaver, DNP, MSN, RN-BC, who leads the EndoTool Operational Readiness Project for Temple Health.
“That meant engaging multidisciplinary stakeholders early and consistently, using proven change management frameworks to guide the transition, empowering nurses and PCAs to codesign future-state workflows, and testing and refining ideas to ensure feasibility and safety,” Weaver continues. “Over the course of a year, these teams collaborated to build workflows that were clinically sound and operationally sustainable. Once our new dietary and nursing workflows were validated by staff, the supporting EndoTool software configuration could be layered on top—ensuring technology supported the process, not the other way around.”
Rather than launching EndoTool across the entire Health System all at once, we proceeded campus-by-campus, allowing us to apply the lessons learned at each hospital. We started at TUH-Jeanes Campus, then TUH-Main Campus, Fox Chase Cancer Center, and TUH-Episcopal Campus; Temple Health-Chestnut Hill Hospital and Temple Women & Families Hospital will go live with EndoTool in late fall 2025.
The training itself was also “tiered,” says Carter Short. “The end users—our RNs, APPs, and physicians—completed an online module, and nurses received in-person training,” she explains. “After that, they had shoulder-to-shoulder support around the clock. There was a Teams chat where staff could ask questions and we’d provide immediate feedback. The Super Users would also go directly to the units to help staff and physicians resolve any issues in real time.”
Engaging Staff with Super Users
The Super Users—clinical nurses who volunteered to complete extensive training to teach others how to use EndoTool—turned out to be the key to our successful rollouts.
“The Super Users were really the voice of EndoTool,” says Joan Madalone, DNP, MS, RN, MHCDS, CCRN, NE-BC, Associate Vice President of Nursing at TUH-Main Campus. “They were so clinically savvy and well-versed in EndoTool that they supported everyone through the implementation process.”
“We gave them cell phones they could carry around and yellow vests so everyone would know who they were,” explains Joseph DiMartino, MSN, RN, NE-BC, CCRN, Associate Vice President of Nursing at TUH-Main Campus. “We posted those phone numbers on the unit, so employees knew who to call if they had a problem.”
“The Super Users brought back real-time feedback from staff, and we made tip sheets and implemented changes based on those conversations,” Carter Short says. “If they weren’t getting any calls, they would go around the floors and provide education and support. They were phenomenal; we couldn’t have asked for a better group of nurses. They told us, ‘We’ll do whatever you need.’”
Innovative Tools Show Immediate Success
Thanks to the effective execution of the rollout, staff feedback has been overwhelmingly positive. “I’ve been conducting my Brief with the Nursing Chief by intentionally rounding over the past few months to hear directly from employees,” Carter Short says. “Whenever the topic of EndoTool has come up, I haven’t heard one complaint. I believe the staff truly felt well-prepared and supported throughout the process.”
Another key factor in the enthusiastic response? How quickly it became clear that EndoTool was making a real difference for patients. “I think seeing dramatic results so fast was the ‘aha’ moment,” Carter Short says.
Care teams were able to track EndoTool’s impact thanks to the development of a real-time Power BI glycemic dashboard, created in collaboration with our Business Intelligence Systems team. This dashboard not only provides immediate visibility into hypoglycemic events, allowing clinicians to respond quickly and appropriately, but also tracks glycemic trends across campuses and individual units. By surfacing patterns in both hypo- and hyperglycemia, the dashboard supports proactive care planning and targeted interventions. This strengthened the sustainability of the change by embedding data-driven decision-making into daily clinical workflows and fostering continuous improvement in patient outcomes.
“At TUH-Main Campus, we saw positive results very early on, starting in week one,” DiMartino explains. “Employees could tell their hard work was paying off, and if anyone was feeling frustrated, that really helped them commit to the process.”
Comprehensive Diabetes Education Ensures Exceptional Care
At the same time, we also recognized that effective diabetes management doesn’t start and end with new tools—which is why we committed ourselves to providing comprehensive diabetes education alongside the EndoTool rollout. This project was led by Meaghan Kim, MHA, BSN, RN, CDCES, Assistant Vice President of Population Health, a self-professed “diabetes geek.”
“We wanted to make sure our nurses had foundational knowledge about diabetes as a disease,” Kim explains. “We began at Jeanes Campus, going unit-by-unit to walk nurses through the key concepts of insulin therapy: specifically, the onset, peak, and durations of the insulins they administer at the bedside. We discussed the roles of basal and bolus insulin, explained how EndoTool calculates individualized dosing for each patient, and how that might impact what they administer. We also provided guidance on how to effectively teach patients to use an insulin pen.”
“We received really positive feedback from that experience, and used it to shape our experience at Main Campus,” Kim continues. “I brought all the Super Users together for a one-hour training and prefaced it by saying, ‘I know you’re caring for high-acuity patients; this is simply a foundational session on insulin and diabetes management.’ Still, many of them came back to say, ‘Every nurse needs this. I walked away with real pearls of wisdom.’”
That knowledge made the Super Users especially effective in educating their fellow employees and troubleshooting any issues at the bedside. And even while the official EndoTool rollout has wrapped up at most of our campuses, Kim and her team are still conducting education.
“We have a plan to distribute insulin pen teaching kits to nursing units across the entire Health System, so nurses are equipped to confidently teach patients how to use them,” Kim explains. “As part of that effort, we’ll also reinforce the rationale behind using EndoTool, explain how it works, and provide a refresher on basal and bolus insulin. It’ll be all about getting back to the basics.”
“Placing Diabetes Care at the Forefront”
For Kim, the EndoTool rollout is a reflection of Temple Health’s emphasis on ensuring the best possible outcomes for patients with diabetes. “It’s so exciting to work at an organization that’s really placing diabetes care at the forefront,” she says. “There’s just such a laser focus on it at Temple.”
As she points out, diabetes treatment is a national issue—and one that’s especially important for the communities Temple Health serves. “Nationally, about 25-35% of inpatients at any time have a diabetes diagnosis,” Kim explains. “TUH-Main Campus’ diabetes diagnosis rate is closer to 50%, which highlights the importance of sustained diabetes education and a continued emphasis on nursing.”
And thanks to this approach—combined with EndoTool’s advanced technology—Temple Health is providing the highest-quality diabetes care.