Purpose: To establish standardized care to improve the perioperative glycemic control of Type 2 diabetics undergoing coronary artery bypass graft (CABG) surgery and decrease the incidence of postoperative surgical site infections (SSI).

Design: A performance improvement (PI) model was used to change  practice among the nursing and physician staff. An evidence ­based protocol was developed to improve the standard of care for to Type 2 diabetic CABG patients. The site was a large middle eastern hospital where 59% of  the CABG patients were Type 2 diabetics.

Methods: During a 3-year period, 525 diabetic patients underwent CABG. The protocol addressed all phases of care. Data was collected during the hospitalization to assess the impact and outcomes following implementation of the protocol.

Results: During a 3-year period 891 CABG surgeries were performed. Of these, 525 (59%) were Type 2 diabetics.  Using a protocol developed from a review of the literature, glucose levels on 3 critical days were targeted at 11.1 mmol/L (200 mg/dl), and were significantly reduced from pre-intervention levels. Pre-intervention postoperative SSI rates were 10.2%. 85% of the SSI occurred in diabetic patients. The following year the SSI rate remained unchanged at 10.1%. However, the incidence of SSI in diabetic patients decreased to 61%, a decrease of 24% in the target population.

Conclusions: These findings support intensive glycemic control in Type 2 diabetics, and standardization of treatment for CABG surgery in this population. The use of a PI model provided a framework that can be easily adapted to a variety of clinical settings to optimize control of difficult patient care problems.  The resulting reduction in expenditure of health care resources for the treatment of untoward events can be significant.