Summary
The database was created after NEE CCG handed over the service budget and commissioning of the insulin pump service to North East Essex Diabetes Service (NEEDS). Initially there were a variety of sources of information, each holding different types of data, making it difficult to gain a clear picture of which patients were funded, for what and when insulin pump renewals were due. At the same time, all of the insulin pump patients were being transferred across from the existing pump service and the team needed a way to track their clinical outcomes. The new database allows tracking of pump consumable ordering, pump warranty information, clinical outcomes, HbA1c, and so on, providing a ‘live’ picture for use in clinical audit and financial tracking.
Results
There is now an accurate and reliable single source of information on all insulin pump users/service users in North East Essex. Records include why and when they went on pump, which team sees them clinically, which type of pump, how often and what they order in pump consumables, any faults with the pumps that lead to replacement and GP information. Clinically the database holds information of their clinical outcomes pre-pump and then yearly on the pump which then forms part of the annual review. A proforma score sheet for the annual review has weightings based on a series of 10 questions and can be used as a decision making tool, and part of deciding whether a patient should continue pump therapy. The database can be used to run reports to create a list of all patients in the area that fall into certain search terms (e.g. those on a certain type of pump, those who started pump in a certain year, those who are overspending on consumables, anyone with a pump warranty ending in the next few months). These search terms can be adapted to what is needed as the service requirements evolve. The two members of the team are now able to make amendments to the database as required whether it is structural, adding extra buttons or creating new reports and changing the parameters set.
Challenge
After taking over the commissioning role from the CCG, alongside the clinical role from the hospital service, it quickly became clear that there were large gaps in the information that the commissioners had previously held, compared to that held by the clinical service. The insulin pump companies were sometimes unsure as to who should cover the funding for some patients, so a lot of time was spent looking into all of the different sources of information to try and develop a clear picture of what had gone on with individual patients in the past. This was beginning to impact on clinician staff time, and could not continue in the longer term.
Objectives
To provide easy access to all information on insulin pump patients in the NEE area via an easy to use database to determine funding and replacement issues. To track clinical outcomes and yearly patient audit, with enough flexibility to create audits on any of the documented information held within the database at any point in the future.
Solution
The team met with other trusts which had some form of database to monitor their pump patients to discuss their experiences and any learning points. An IT consultant was hired as ultimately it would improve the service, save staff time and potentially lead to cost savings in consumable monitoring. Over 6 months working with the IT consultant, the team received training in the IT programme, then jointly developed and tweaked the database. There were test phases to enter and analyse the data, then sessions to make adjustments to any areas that needed improving. Extra pages for additional information were added as time went on.
Learnings
Make other teams aware of the benefit of having a combined clinical / commissioning database from as early as possible in the new service and work out what kind of things to monitor as part of the commissioning service. The database can assist with budget planning and projections and is a useful tool in clinical audit saving time, while a structured approach to patient information allows quick and easy details to be extracted. It is a useful way to combine two differing sources/layouts/formats of information. Having such a database allows for timely responses and resolution of any issues with the patient care.
Evaluation
It is thought that no other service has shared such a database, and due to the time and effort put into this at the beginning it is an excellent tool to improve all aspects of care. These ideas could easily be adapted to suit similar service needs in other geographical areas and expanded as required.
