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Diabetes assessment tool cuts hospital stays

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A tool to help nurses manage the care of inpatients with diabetes, particularly those admitted for non-diabetes related problems, has significantly improved patient care at an acute trust in the East Midlands.

Worcestershire Acute Hospitals NHS Trust conducted a 12-week pilot of a new toolkit, developed by the NHS Institute for Innovation and Improvement as part of its ‘ThinkGlucose’ campaign.

The primary goals of the tool are to help ward staff identify patients who have diabetes early, and determine whether specialist diabetes team input is required for their care and to what degree the patient can self-manage their diabetes during their hospital stay.

Using a checklist, nurses categorised diabetes patients as level one, two or three, with level one patients requiring early referral to a diabetes nurse specialist (DNS) and level three patients likely to be able to self-manage their condition.

The pilot ran from October 2008 to January 2009. Prior to the implementation of the tool, only 36% of inpatients were being appropriately referred to the DNS, and the average length of patient stay was nine days. But after just 12 weeks, 61% of inpatients were being appropriately referred, and the average length of stay had been cut to just seven days, saving the trust around £1m per year.

‘Patients with diabetes were picked up much more quickly using the tool, and early referral to a DNS meant that far more patients were able to self-manage their diabetes by the time they were discharged, decreasing the need for district nurse support,’ said Emma Innes, diabetes nurse specialist at the trust.

‘It has also helped raise the profile of diabetes within the organisation, and people are now realising that if you get the management right at the beginning it improves the patient experience and reduces costs,’ she added.

As part of the ‘ThinkGlucose’ campaign, launched last month, the NHS institute is sending free ‘ThinkGlucose’ packs to all acute trusts in England, with guidance on the safe use of insulin and how to measure improvements in patient care.

They are also holding a series of national launch events over the next two months at acute trusts across England to raise the profile of the campaign.

‘Around 10% to 20% of inpatients at any one time have diabetes, yet the management of this large group has not really been tackled before in the diabetes world,’ said Sandra Corry, the NHS Institute’s programme lead for the ThinkGlucose campaign.

‘Some areas are not identifying inpatients with diabetes soon enough, and there are real variations in practice. The campaign aims to achieve large scale change by earlier recognition of diabetes and equity of care across all NHS trusts in England,’ she added.

The ThinkGlucose campaign team will be in Manchester on 19 May, before moving on to Edgbaston, Cambridge and Taunton in June.

* New guidance on the management of foot care for patients with diabetes will be published on 12 June by NHS Diabetes. The new ‘Putting feet first’ guideline will form part of a campaign to improve the care of diabetic foot ulcers and reduce diabetic leg amputations in the UK.

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