Management of raised glucose, a clinical decision tool to reduce length of stay of patients with hyperglycaemia.

OBJECTIVE: To assess whether the introduction of a management of raised glucose clinical decision tool could improve assessment of patients with hyperglycaemia by non-specialist physicians, leading to early discharge and improved quality of inpatient care. METHODS: Participants were adults aged 18 years or over presenting to the Medical Assessment Unit with a capillary blood glucose level > 11.1 mmol/l. Phase 1 of the study (phase 1) evaluated current clinical practice and potential impact of the clinical decision tool. Phase 2 evaluated the effectiveness of the management of raised glucose tool in clinical practice. Primary outcome measures were inpatient length of stay and same-calendar-day discharges. Secondary outcome measures were diabetes specialist input, patient assessment, intravenous insulin infusion use and patient satisfaction. RESULTS: Implementation of the management of raised glucose clinical decision tool allowed safe, same-calendar-day discharges of 40% of patients with hyperglycaemia as their primary reason for attendance. Median length of stay was lower in the phase 1 than in phase 2 (1.0 vs. 3.5 days, P < 0.01). Early discharge did not result in an increase in readmissions. There was improvement in hyperglycaemia assessment for all patients (P < 0.01), a reduction in the use of intravenous insulin infusions (P < 0.01) and high level of patient satisfaction. CONCLUSION: The management of raised glucose clinical decision tool resulted in a significant increase in the number of same-calendar-day discharges and reduction in hospital length of stay without adverse impact on readmission rates. Additionally, the tool was associated with improvements in inpatient diabetes care and patient satisfaction.

Can an interprofessional education tool improve healthcare professional confidence, knowledge and quality of inpatient diabetes care: a pilot study?

AIMS: To conduct a pilot study evaluation of an interprofessional education tool that could improve healthcare professional confidence, knowledge and quality of inpatient diabetes care. METHODS: Diabetes specialists designed an education tool for use in the hospital environment to educate qualified pharmacists, nurses, healthcare assistants and junior doctors. The interprofessional learning enabled professionals to learn from and about each other. The education tool was piloted at four hospitals. Diabetes specialists delivered the education programme to 31 healthcare professionals over 8 h either as three individual teaching blocks or a whole day. Healthcare professionals completed a multiple choice questionnaire before and after the education intervention to evaluate acquisition of knowledge. The maximum score was 20. Confidence was evaluated using categorical questions. Diabetes specialists used a clinical audit form before and after the education programme, to evaluate the quality of diabetes care. RESULTS: Healthcare professional's confidence improved from 58 to 94% (P < 0.05) and knowledge improved from 12.4 ± 0.6 to 15.0 ± 0.6 (mean ± sem, P < 0.05). There was a reduction in management errors from 74 to 44% (P < 0.05) and improvement in appropriate blood glucose monitoring from 67 to 92% (P < 0.05). The number of patients with documented foot assessment improved from15 to 33% (P < 0.05). Improvement in the number of appropriate diabetes referrals and reduction in prescribing errors did not reach statistical significance. CONCLUSION: The education tool improved healthcare professional confidence, knowledge and may improve the quality of inpatient diabetes care.