NURS 834 Week 4 Practice Initiative Project Part II Business Case Presentation Example

Owning Glucose Across the Hospital: A Business Case to Executive Leadership for a Nurse Practitioner-Led Inpatient Glycemic Management Team, Year-One Request $382,000

Slide 1: Executive Summary

• Request: approve an NP-led inpatient glycemic management team
• Year-one cost: $382,000
• Projected year-one benefit: about $640,000
• Return on investment: 68%; break-even near month 7

Speaker notes: Thank you for your time. We are asking for approval and first-year funding of $382,000 for a nurse practitioner-led team that owns glucose management across the hospital. Our conservative projection is about $640,000 in first-year benefit from shorter stays, fewer severe hypoglycemic events and consult revenue. The rest of this presentation shows where those numbers come from and what happens if they are smaller.

Slide 2: The Problem in Our Hospital

• Severe hypoglycemia (glucose below 54 mg/dL) up 40% in one year
• 11 rapid response calls a month for low glucose
• Patients with diabetes stay 1.2 days longer than matched patients without

Speaker notes: About one in four of our inpatients has diabetes. Severe hypoglycemia has risen sharply, and each event means bedside treatment, often a rapid response call and sometimes a transfer. Patients with diabetes also stay longer for the same conditions, largely while insulin is adjusted before discharge.

Slide 3: Why It Is Happening

• No clinician owns glucose across units
• Basal-prandial order set used in under half of insulin orders
• Meals and insulin poorly coordinated
• No inpatient endocrine consultation

Speaker notes: The causes are system problems, not individual errors. Fourteen hospitalists each manage glucose differently, sliding-scale insulin alone remains common and there is no specialist service to call.

Slide 4: What the Evidence Shows

• Hospital diabetes services pay for themselves through fewer lows and quicker discharges (Haque et al., 2021)
• Early specialist consult: 1.56 fewer days in 11,477 stays (Sheahan et al., 2021)
• Works in community hospitals as well as academic centers (Zilbermint, 2021)

Speaker notes: Across the studies Haque and colleagues reviewed, hospital diabetes services improved care and lowered cost, chiefly through quicker discharge, fewer returns and fewer dangerous lows (Haque et al., 2021). Sheahan and colleagues found that general medicine patients with diabetes who saw a diabetologist in their first two days went home about a day and a half sooner, with no change in complications or readmissions (Sheahan et al., 2021). Our projections assume only a third of that effect.

Slide 5: The Proposed Team

• Two nurse practitioners, 7 days a week coverage
• Diabetes nurse educator (existing position)
• Pharmacist partnership for insulin review
• Hospitalist medical director as physician sponsor

Speaker notes: Two nurse practitioners provide daily coverage, with the existing diabetes educator handling teaching and discharge preparation. A pharmacist reviews insulin orders flagged by the daily report. The hospitalist medical director serves as physician sponsor and escalation point.

Slide 6: How It Works

• Daily automated report flags glucose below 70 or above 250 mg/dL
• Team sees flagged and consulted patients within 24 hours
• Consult model: recommend, then write orders with hospitalist agreement
• Remote review on weekends extends reach

Speaker notes: An automated report identifies patients at risk every morning. The team reviews them and sees patients within a day. Remote review, modeled on a remote service that lowered the share of hyperglycemic patients by nearly seven points at an academic center (Mendelsohn Curanaj et al., 2026), lets two nurse practitioners cover the whole hospital.

Slide 7: Alignment With Our Strategy

• Patient safety priority: reduce hypoglycemia
• Throughput priority: reduce avoidable bed-days
• Mission: excellent care close to home

Speaker notes: Waxman (2018) places strategic alignment at the center of a nursing business plan. This initiative serves two of this year's organizational priorities and our mission of keeping complex care in our community.

Slide 8: Year-One Budget

• Two NP salaries with benefits: $337,500
• Order set and report build (one-time): $25,000
• Staff education: $9,500
• Glucose management software license: $10,000
• Total: $382,000

Speaker notes: Personnel is almost 90% of the cost. Salaries assume $135,000 per nurse practitioner plus 25% benefits. The one-time build and education costs fall only in year one.

Slide 9: Projected Savings and Revenue

• Shorter stays: 1,200 patients x 0.5 day x $600 variable cost = $360,000
• Severe hypoglycemia avoided: 110 events x $1,200 = $132,000
• NP consult revenue, net of collections: $148,000
• Total projected benefit: $640,000

Speaker notes: Each line rests on an assumption. Length of stay savings assume half a day for 1,200 high-risk patients at our variable cost per day of $600, a third of the published effect. Avoided events assume a 50% reduction from 220 severe events a year at an estimated $1,200 each for treatment, rapid response and monitoring. Consult revenue reflects expected professional billing at our payer mix.

Slide 10: Return on Investment

• Net benefit: $640,000 minus $382,000 = $258,000
• Return on investment: 68% in year one
• Break-even: about month 7
• Year two: one-time costs fall away; return rises

Speaker notes: To get the return, we divide what is left after costs by what we are asking you to spend. Because benefits build as the service grows, we expect to cover monthly costs by about month seven. In year two, without the one-time costs, the return improves.

Slide 11: What If We Are Wrong?

• Length of stay savings halved: ROI 20%
• No length of stay savings at all: ROI negative 27%, but safety gains remain
• Hypoglycemia reduction of 25% instead of 50%: ROI 50%

Speaker notes: If length of stay falls by only a quarter day, the return is still positive. If it does not fall at all, the program would cost about $100,000 more than it returns in year one, and we would ask you to judge that cost against fewer severe hypoglycemic events. Length of stay is the assumption that carries the most risk, so it is the one we will measure first. A projection earns trust when it shows the reader the number that could break it.

Slide 12: Risks and How We Will Manage Them

• Hospitalist acceptance: consult model, medical director sponsorship
• Recruitment of second NP: internal candidate identified
• Data quality: validate report against 50 chart reviews
• Scope creep: defined consult criteria

Speaker notes: The greatest risk is that physicians will not use the service. Starting with a consult model and the medical director's sponsorship addresses that directly. If, at month three, fewer than half of flagged patients are being seen, we will meet with the hospitalist group to find out why before spreading further.

Slide 13: Implementation Timeline

• Months 1 to 4: build order set, protocol, report; hire
• Months 5 to 7: pilot on two units
• Months 8 to 10: hospital-wide spread
• Months 11 to 12: outcomes report to board quality committee

Speaker notes: The timeline follows our work plan, with a pilot before spread so that we learn on two units before committing hospital-wide.

Slide 14: How We Will Measure Success

• Severe hypoglycemia per 100 insulin patient days: down 50%
• Glucose values above 180 mg/dL: down 10 points
• Length of stay for patients with diabetes: down 0.5 day
• Balancing: 30-day readmissions not increased

Speaker notes: Nursing leaders will see these numbers every month and the board quality committee every quarter, with run charts showing change from baseline.

Slide 15: Our Request

• Approve the NP-led inpatient glycemic management team
• Fund year one: $382,000
• Decision requested by the end of this quarter
• First report to you at month 6

Speaker notes: We ask for approval and funding this quarter so that hiring can begin and the pilot can launch within five months. We will return at month six with pilot data and our first look at length of stay. Thank you.

References

Haque, W. Z., Demidowich, A. P., Sidhaye, A., Golden, S. H., & Zilbermint, M. (2021). The financial impact of an inpatient diabetes management service. Current Diabetes Reports, 21(2), Article 5. https://doi.org/10.1007/s11892-020-01374-0

Mendelsohn Curanaj, F. A., Rajan, M., Snead, J., McCullough, P., & Lee, J. I. (2026). Delivery of guideline directed care for inpatient glycemic management: Quality improvement implementation. Journal of Diabetes Science and Technology. Advance online publication. https://doi.org/10.1177/19322968261417369

Sheahan, K. H., Atherly, A., Dayman, C., & Schnure, J. (2021). The impact of diabetology consultations on length of stay in hospitalized patients with diabetes. Endocrinology, Diabetes & Metabolism, 4(1), Article e00199. https://doi.org/10.1002/edm2.199

Waxman, K. T. (2018). Financial and business management for the doctor of nursing practice (2nd ed.). Springer Publishing.

Zilbermint, M. (2021). The endocrine hospitalist: Enhancing the quality of diabetes care. Journal of Diabetes Science and Technology, 15(4), 762-767. https://doi.org/10.1177/19322968211007908