OBJECTIVES: Hyperglycemia in the critically ill, non-diabetic patient has been shown to negatively affect clinical outcomes. Administration of continuous insulin infusion (CII) to maintain blood glucose (BG) between 80-110mg/dL has thus become standard of care. The objective of this study was to compare the costs and BG levels associated with glucose control among patients pre- and post- CII protocol implementation in an intensive care unit (ICU). METHODS: Combination of time-in-motion (TIM) observations and retrospective random chart review to compare glucose control and costs in 2001 and 2004, prior to and after CII implementation respectively. TIM data determined time spent on activities related to glucose management and chart data determined frequency of respective activities per year. Study population included ICU patients >16 years old, mechanically ventilated for >12 hours, with no diagnosis of diabetes. Costs were determined for glucose monitoring with no insulin orders (2001), glucose management with sliding scale subcutaneous insulin (2001), and management with CII protocol (2004) using 2005 US$ from the hospital perspective. RESULTS: From a total 460 charts in 2001, 49 (11%) were reviewed. From a total 540 charts in 2004, 83 (15%) were reviewed. No differences in age, gender, marital status, or race by year were noted (p>0.05). Costs (mean +/-SD) associated with monitoring and no insulin were $0.16 +/-0.56 (median=$0.00) per patient day, with subcutaneous insulin $10.08 +/-4.96 (median=$8.42), and with CII protocol $21.87 +/-3.90 (median=$22.49). Mean +/-SD daily blood glucose values were 138 mg/dL +/-24, 157 mg/dL +/-32, and 108 mg/dL +/-10, respectively. Regression analysis demonstrated statistical differences in BG (p<0.01) by method. CONCLUSION: Costs associated with CII protocol are more than twice the costs of sliding scale subcutaneous orders per patient day, but result in recommended BG values below 110 mg/dL. Impact of costs on hospital policy will be discussed.