Implementing a hypo pathway in North Mersey

Download: Success Story Summary, January 2012 (PDF 217.5KB) / Award Entry Form (PDF 205.5KB)  

The challenge 

The North Mersey Diabetes Network (NMDN) identified that a lack of communication between primary care, secondary care and the ambulance service about patients who experienced hypos was leading to missed opportunities to reduce further hypo episodes. They also wanted to address standard 7 of the Diabetes NSF and the North Mersey Quality Innovation, Productivity and Prevention (QIPP) agenda and find ways to provide care closer to home whilst reducing avoidable A&E attendances. 

Aims 

The aim was to provide seamless care for patients and to reduce A&E attendances, whilst building relationships and improving liaison between all staff groups involved in diabetes care. The project aims included improving patient care and safety, reducing the number of future hypoglycaemic events though education and support and improving liaison between primary care, secondary care and ambulance crews. 

What did they do? 

The NMDN and North West Ambulance Service (NWAS) established a steering group with representatives from the diabetes specialist nurse (DSN) teams in primary and secondary care, service user representatives, and NWAS staff. The group developed and piloted a new hypo pathway and information sharing protocol for the management of hypos across the North West. This was supported by the delivery of additional training to ambulance staff by the DSN teams. The pathway was piloted for six months. 

Patients who experienced a hypo and were seen by NWAS were referred by ambulance staff to their community diabetes team and received a follow-up call from a DSN within five days. The DSN offered the patient a comprehensive hypo assessment, including education and support to help prevent recurrent hypos. The DSNs also made recommendations to the professionals involved in the patient’s diabetes care and informed their GP of the hypo event and any subsequent change in treatment. 

What happened? 

A minimum evaluation data set was agreed and NMDN manager agreed to collate data on behalf of teams taking part in pilot to demonstrate the impact on services, patient satisfaction clinical time and hospital admissions. 111 patients were followed up using the new hypo pathway. All patients who gave consent to be contacted received general education and clinical support via a telephone consultation. 74% of patients were safely seen and treated at home by ambulance staff. This equates to a potential £8,190 saving in A&E attendance costs. 

Patient feedback has been positive and patients and carers have reported their knowledge and awareness of hypo management had increased. Anecdotally NWAS staff have reported they are more confident to leave patient at home as there is a follow up pathway in place. All DSN teams have reported the pathway has significantly impacted on improvements in care without greatly increasing their workload. An improvement in communication between primary care, secondary care and the ambulance service has led to avoidable patient attendances at A&E and improved care for patients.

Key outcomes

• Reduced A&E attendances following hypos – pilot savings equate to £8000
  
• Improved knowledge among ambulance staff
  
• Improved communication between primary and secondary care and ambulance service