Prediabetes Screening in the Emergency Room

Diabetes continues to be a leading cause of morbidity and mortality and contributes substantially to healthcare costs. Prediabetes indicates a future risk for diabetes. Consequently prediabetes screening is paramount in combating our country's diabetes problem. The Centers for Disease Control and Prevention (CDC) offers a valid and reliable prediabetes screening tool (PST) for assessing prediabetes risk. Millions of emergency room (ER) visits occur each year and ERs frequently provide care to those with unfulfilled primary care needs. For this reason, screening for prediabetes in the ER using the CDC screening tool may be an ideal approach for improving diabetes prevention. A review of the literature revealed prediabetes prevalence is quite high in the United States (U.S.) and that many Americans remain unaware that they have prediabetes. Screening is recommended in asymptomatic adults with certain risk factors, however screening may not always occur during an individual's annual physical exam. Millions of Americans with unmet primary care needs or inadequate primary care access receive care in ERs. Researchers have reported on the rather large prevalence of prediabetes among ER patients following screenings in emergency rooms. However, the literature also revealed barriers to screening and other preventive practices faced in the emergency room. Most notably of which are prolonging the length of a patient's stay in the ER and diverting ER staffs' attention away from patients' acute care needs. The objectives of this project included: 1) modify the CDC PST for use in the ER 2) implement the PST in the ER 3) assess barriers and facilitators to screening for prediabetes in the ER, 4) evaluate the feasibility of screening for prediabetes in the ER, and 5) disseminate the project's results and investigator's recommendations to a larger audience. This project was implemented in an urban academic medical center's emergency room. Emergency room nursing (RN) staff were briefed on the project prior to its implementation. This was accomplished during several RN staff shift changes. Over the course of the project's implementation, feedback regarding perceived barriers and facilitators to screening was obtained from the ER staff. The ER RN staff and principal investigator screened patients in the ER's lower acuity wing with 20 patients successfully screened. Thirty-five percent of the 20 patients screened were determined to have a high risk for prediabetes. The most frequently reported risk factors were an elevated BMI and family history of diabetes. Perceived barriers to screening were related to time, patients acute care needs and lack of follow up. Facilitators for screening included spare time, predetermined plan of care and support from management. Results and recommendations following implementation of the project will be discussed with ER staff and administration, as well as with the leadership and staff of the local National Diabetes Prevention Program. Screening for prediabetes is a critical component in reducing the health burden of the current diabetes epidemic. The CDC PST offers a simple approach for identifying an individual's risk for prediabetes. Screening for prediabetes in the ER may be another avenue by which to enhance diabetes prevention.