Summary
Inspired by the ‘Surviving Sepsis Campaign’, the ‘Start with the Diabasics’ initiative was started – the first inpatient diabetes-branded initiative seeking to raise the hospital-wide profile of the need for all ward-based healthcare professionals to support the basic diabetes care needs of their patients. It seeks to ensure that supporting diabetes care is ‘business as usual’ for all clinical staff. Since launch, awareness of their role in supporting diabetes care has increased among other clinical teams, referral numbers to the diabetes team and referral quality have reduced and increased, respectively, in a replicable initiative.
Innovation
University Hospital Southampton hosts 200 inpatients with diabetes daily. The specialist diabetes team often received inappropriate referrals from other teams, with queries that could be resolved using easily accessible guidance. Adverse events had occurred when teams ignored diabetes. Addressing basic queries reduced time spent on greater needs. Diabetes UK selected Southampton to receive support from its Health Systems Change team on an improvement project. Meetings with the Change team (June 2022 to March 2023) established the goals and benchmarks for success. Based on feedback from 200 staff and people with diabetes, ‘D1ABETES’ was launched – an acronym for ‘Diabetes identification, type 1 diabetes, Acute admission, Blood glucose monitoring actions, Eating and drinking, diabetes Treatments, Education & Safety’, underpinning the ‘Start with the Diabasics’ initiative. Following the official launch in May 2023, the diabetes team visited all wards to deliver themed project merchandise and talk to staff to reinforce awareness. Service referrals would be scrutinised for appropriateness and evidence of guideline use. The Diabasics brand would be used for all formal staff training sessions to maintain awareness. The aim was that all staff should be able to contribute to basic care confidently. The innovation was in: taking a systematic approach to problems; using perspectives from clinical staff outside the team to challenge assumptions and sense-check the approach; brainstorming prototypes, with external feedback; creating a distinct brand differentiated from other NHS materials, plus creating an initiative, not just a campaign, including significant relationship building with stakeholders across the hospital, to lay the foundation for Diabasics’ launch.
Equality, Diversity and Variation
All inpatients should expect a high standard of diabetes care, regardless of ward, social background or ethnicity. The team is inclusive and diverse and will support any patient. Project planning included checking ideas with ward staff from culturally and ethnically diverse backgrounds outside the team and patients with diabetes. The Diabasics marketing posters contain visuals of healthcare workers from different ethnic groups. Through this initiative, Diabasics marketing, ward visits and presentations, the importance and need for all staff to support basic diabetes care was embedded. The need to only refer after basic actions have been commenced, using existing guidance, is clear to staff. The aspiration is to create a better and safer hospital experience for all patients with diabetes. The ‘D1ABETES’ pillars of Diabasics guidance give staff a framework from which to update their knowledge, including a local guidance app. Wards with high levels of inappropriate referrals or patient harm received enhanced support. Reducing ‘inappropriate referrals’ gives the inpatient team more capacity to assess patients with more complex needs. New members of staff view an ‘introduction to diabetes in hospital’ safety video, which covers the Diabasics initiative. This video can be easily shared at scale with all staff.
Results
Before project launch, the diabetes service typically received 20-30 referrals a day from other teams. Often, the information provided was limited and diabetes needs had not been acknowledged. It was made clear that inappropriate referrals would no longer be accepted. Two months into the campaign, referral numbers had fallen by 10-20%, with reason for review more clearly outlined. There was no evidence of reduced referral rates at the expense of persistent hyperglycaemia or hypoglycaemia, based on networked blood glucose meter daily notification data. Teams only contacted the diabetes team to sense-check their approach and confidence increased among staff on wards with high diabetes prevalence. Many of the 44 hospital wards had Diabasics posters displayed and the diabetes team wore Diabasics T-shirts on ward visits to maintain awareness. Most staff appreciated the need to collectively support patients. A diabetes study day, attended by 80 nurses working trust-wide, increased confidence in their ability to deliver basic diabetes care. More are booked. The aim is to reduce the likelihood of clinical errors and harm to people with diabetes, resulting in a better, safer hospital experience. The relationships built supported the importance of diabetes care and the role of all staff. Constant reinforcement will be needed. The project was funded through an educational grant from Diabetes UK. The two medical and nursing service leads gave their time free. It was designed so that the basic diabetes requirements were relevant to all 44 wards and easily translatable to other ward-based settings. Most of the grant was spent on producing Diabasics-themed merchandise to maintain brand awareness.
User Feedback
Feedback statements were obtained post launch by the team, from individuals who were at the launch or heard through internal communications or social media. Responses were positive.
Dissemination and Sustainability
The project was devised for the whole 1,100-bed hospital, to raise the profile of diabetes care needs, which can be overlooked and not prioritised. Pressure will be maintained to ensure that other teams address the basic diabetes needs for their patients. If this is undertaken repeatedly and at scale, this should help reduce diabetes-related delays in care, risks of diabetes-related patient harm, plus length of stay, while giving a more positive patient experience. The rates and nature of adverse clinical events will be monitored and fully investigated, with shared learnings disseminated widely. Social media generated enquiries from 10 hospitals on how the project was developed. A presentation will be made to the NHS England Patient Safety Team. The branded visuals have been shared freely nationally, so other teams can use them. This approach can be adapted for use in other hospitals, without the need for significant new investment. Learnings will also be shared with the Diabetes UK Diabetes Leadership Community
