Summary
Portsmouth Diabetes team identified inequity of care for diabetic inpatients as only a small percentage of those requiring specialist input were being referred.
To address this issue a new service was developed which allowed all patients with diabetes to be reviewed by a member of the specialist team.
This DIPPS service resulted in a number of improvements against performance indicators including reduction in length of stay, readmission rates, sepsis and intravenous insulin use. The service is currently being extended to include all surgical specialities as well as the initial four pilot areas.
Results
Audits show key performance benefits as follows:
- Reduced length of stay in hospital (mean 1.4 days per patient)
- Up to 66 per cent reduction in re-admission rates
- 25 per cent reduction in hospital acquired sepsis
- 50 per cent reduction in hospital acquired hypoglycaemia
- 25 per cent reduction of intravenous insulin infusion use and discontinuation of unnecessary infusions in 30 per cent of patients,
- 50 per cent increase in achieving euglycaemia
- 75 per cent improvement in diabetes care planning
- Identification and correction of prescribing errors in 44 per cent of patients
- 70 per cent improvement in patient and staff satisfaction surveys (these figures may relate to one or more stream).
Challenge
Around 18 per cent of inpatients at Portsmouth Hospitals NHS Trust (PHT) have diabetes. Quality and experience audits revealed poor diabetes management and experience with worse outcomes for diabetic patients admitted for primary reasons other than their diabetes.
Patients with diabetes are twice as likely to be admitted to hospital and have lengths of stay twice that of non-diabetic patients and higher complication rates (NSF diabetes 2001).
Before November 2008 the diabetes team at PHT offered inpatient contact only in response to ward requests but only 10 per cent of patients with known diabetes in hospital were referred to the diabetes specialist team (DST) regarding their diabetes management, even if in difficulty and then generally too late to make a significant difference to their admission care.
Solution
The Diabetes Inpatient Prospective Service (DIPPS) was created to review all patients with diabetes across the trust on a daily basis. The goal was to reduce inequity of care for patients with diabetes when admitted to hospital through provision of routine pro-active specialist input into the care plan for all patients with diabetes additional to their primary clinical needs.
The project team divided the Trust into 12 clinical streams of care. Four of these streams (emergency admissions, general surgery, elderly care, renal) were selected as the pilot group.
For each stream a specific specialist team was created to work exclusively within a specific clinical area to develop a team spirit, which included the host specialty and identification of stream-specific issues for improved care and how to provide it.
Alongside proactive visits various practical strategies were implemented to support ward staff and pharmacists including oral drug and insulin therapy reference charts, tri-annual adverse incident review letters and interactive educational IT tools.
Client Verdict
Ursula Ward, PHT Chief Executive has stated that the DIPPS service resulted in improvements against performance indicators and reflects the specialist teams dedication and hard work in improving the care given to patients.
In addition, the Trust has highlighted DIPPS to the SHA and Chief Executive of South England Sir Ian Carruthers, as one of the highlights and achievements of PHT over the last few years.
