Download: Summary Success Story (PDF 168KB) / Full Success Story (PDF 164KB)

The challenge: 

There are 27,000 people with diabetes in Portsmouth. The specialist diabetes service at Queen Alexandra Hospital identified that they were involved in the care of only 6 to10 percent of  people with diabetes being admitted to hospital, or attending for emergency care. The team were concerned this was leading to poorer outcomes and increased lengths of stay (LOS). 

The aim: 

It was clear that to make better use of the diabetes specialist team a prospective and proactive service for in patients with diabetes and/or hyperglycaemia was required rather than relying on the traditional model of involvement only on request from the host ward team.  The aims of the project were to identify known patients with diabetes when they come to hospital and to identify patients who present with hyperglycaemia with a view to improving their care and outcomes in a cost effective way. 

What did they do? 

Led by the diabetes consultant physician and diabetes specialist nurse (DSN), working with the whole diabetes multidisciplinary team (DMDT), an audit was undertaken to assess inpatient diabetes care. The audit was carried out in four key areas of the hospital: the ‘emergency corridor’ comprising A&E , the medical assessment and surgical assessment units; the department of medicine for older people (DMOP); the surgical service (vascular and gastrointestinal including surgical high care) and the regional renal unit. The audit collected baseline data on key areas, including glycaemic control, LOS, patient outcomes and complications and evidence of diabetes therapy adjustment. The audit highlighted a number of critical issues specific to each area (for example that of the 21% of emergency corridor patients who were treated with IV insulin, 70% wer treated inappropriately and 16% of DMOP patients experienced more than two hypoglycaemic episodes during their stay, each associated with an increased LOS of 3 days). 

Following the baseline audit, six month intervention plans were drawn up to address the specific issues in each area. In broad terms, two patterns of involvement were designed either involving direct care from the MDST on a regular basis or education of host teams and liaison management for problem situations. After six months a repeat audit of the care of a 50 consecutive patient data set was undertaken. 

What happened?

The effect of all the interventions derived from the re-audit data was an overall reduction in lengths of stay of 1.43 days for the four streams. This reduction in LOS, combined with other reductions in complications yields a potential annual saving of £2,129,556 if extended across the whole trust. The pilot intervention was achieved within the existing resources of the department; to extend the practices piloted to the remainder of the trust requires a resource allocation of a further 2 whole time equivalent DSNs to complement those already providing combination in-patient and out-patient specialty services. This resource allocation remains the focus of present negotiations within the trust and wider healthcare environment. 

Key outcomes 

• Potential savings of over £2 million due to reduced length of stay. 
  
• A reduction of admissions related to diabetes: 58% to 44% for emergency corridor; 13% - 5% for DMOP. 
  
• The frequency of hypoglycaemic episodes in DMOP decreasing from 16% to 8%. 
  
• A reduction in re-admission rates: emergency corridor from 30% to 10%; DMOP from 18% to 12%, renal by 50%.