Improving diagnostic accuracy of 72-hour supervised fasting test for hypoglycemia evaluation: A quality improvement project

Table 1 Baseline data of patients who were admitted for 72-hour supervised fasting test in Hamad General Hospital (from June 2022 to June 2023), n (%)

Variable	Results
Number of patients	9
Mean age (years), mean ± SD	34.5 ± 11.7
Gender
Females	6 (66.6)
Males	3 (33.3)
Nationality
Qatari	5 (55.5)
Egyptian	1 (11.1)
Sudanese	1 (11.1)
Saudi	1 (11.1)
Filipino	1 (11.1)
Presumed diagnosis
Possible drug induced hypoglycemia	1 (11.1)
Non-specific hypoglycemia for workup	2 (22.2)
Dumping syndrome with recurrent hypoglycemia	2 (22.2)
Recurrent hypoglycemia for workup	1 (11.1)
Possible insulinoma	3 (33.3)
72-HSFT done correctly
Yes	3 (33.3)
No	6 (66.6)
Issues in the 72-HSFT (n = 6)
Labs sent 1 hour after vein glucose reached 3 mmol/L threshold	1 (16.6)
Fasting broken before finishing the test	1 (16.6)
Labs sent with glucose level of 3.7 mmol/L	1 (16.6)
Not done at time of hypoglycemia	1 (16.6)
Done when vein glucose 39 mmol/L	1 (16.6)
Not all labs sent with hypoglycemic event	1 (16.6)
C-peptide (number of times ordered)	36 (4 times per person)
Insulin level (number of times ordered)	35 (3.8 times per person)
BHB (number of times ordered)	35 (3.8 times per person)

72-HSFT: 72-hour supervised fasting test; BHB: Beta-hydroxybutyrate.

Table 2 Impact of quality improvement interventions on 72-hour supervised fasting test performance and C-peptide utilization across study phases

Cycle	n	Median age (years)	Median LOS	Correct test (%) with 95%CI1	C-peptide (total)	Average C-peptide per patient
Baseline	9	34.5 (mean)	5 (4-6)	33.3 (12.1-64.6)	36	4.0
PDSA 1	5	29 (20-35)	4 (4-5)	80 (37.6-96.4)	6	1.2
PDSA 2	3	26 (25-42)	4 (4-4)	100 (43.9-100)	3	1.0

¹Confidence intervals were calculated using the Wilson score intervals.

LOS: Length of stay; CI: Confidence intervals; PDSA: Plan-do-study-act.