Following negotiations with the local CCG the Trust developed the ‘Diabetes Outreach Team’. This team delivers seven-day, proactive ward rounds specifically targeting high risk patients and delivering a comprehensive set of interventions, which includes patient education, direct clinical input, identification and referral to psychology, smoking cessation and structured education programmes. A focus on supporting the emergency department has meant that readmission is avoided as much as possible and diabetic emergencies are dealt with by specialists.
The East and North Hertfordshire NHS Trust caters for a population of 500,000 with just 800 beds, 18% of them occupied by diabetes patients at any one time. The trust is also a dialysis centre and a vascular unit, so sees a high degree of diabetes-related complications.
Data from the annual NaDIA results and local audits showed these patients receiving suboptimal care: 27% had intravenous insulin in situ for an innappropriate length of time, and patients felt that only 74.6% of staff knew enough about diabetes to care for them. Just 33% were seen by the diabetes specialist team, and the diabetes inpatient service was only delivered over a five day period.
Quarterly targets were negotiated with the CCG as part of a CQUIN programme, alongside in-house improvement projects. A business case was made for expanding the inpatient team to form a Diabetes Outreach Team’ (DOT), increasing diabetes-specific ward rounds from five to seven days per week.
CQUIN targets for the end of year one included increasing patient coverage, reducing the use of inappropriately lengthy IV insulin regimes, and cutting insulin administration errors. Other goals included monitoring length of stay and rolling out a foot assessment tool in the renal unit.
All patients were to be reviewed to ascertain their understanding of their condition and medication, and their need of psychological support. Appropriate referrals were then made.
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