‘Think Glucose’ is a national initiative to improve in-patient diabetes care, including the use of a ‘traffic light’ system to give guidance to hospital staff as to which patients should be referred to the in-patient diabetes specialist team (IPDST). Keeping track of the 31 types of case referenced in the ‘traffic light’ scheme can be difficult, however, leading the Trust to develop an electronic form using its iSoft Clinical Manager (iCM) for ‘Think Glucose assessment’. This comprises a simple and mandatory tick box process to assess diabetes patients using the traffic light scheme, with the completed form then sent to the IPDST. Admin staff then add any patients who need to be seen by the IPDST to round lists. There has been a dramatic increase in the number of in-patients seeing the IPDST, while at the same time ensuring that the patients seen are only those requiring it according to the Think Glucose criteria.
In the UK the number of people with diabetes increased by 18% between 2005 and 2008, with more than 4% of the population affected. Diabetes is much more common in South Asian and Afro-Caribbean ethnic groups, who are strongly represented in our West Birmingham/Sandwell locality. Nationally, between 10-20% of acute Trust beds are occupied by patients with diabetes but in our catchment area it is nearer 28%. In addition, diabetic in-patients stay on average 2.6 days longer and insulin administration is one of the treatments most frequently involved in medication-related adverse incidents. The NHS Institute for Innovation and Improvement therefore collaborated with clinical diabetes teams to develop the National Think Glucose Project, with a view to improving the care, outcomes and experience of people with diabetes who are admitted to hospital.
This West Birmingham/Sandwell initiative aimed to implement the National Think Glucose policies using an IT solution.
The project aimed to offer a clear focus on the patient by quickly identifying people with existing diabetes and hypo- hyperglycaemia via a comprehensive and standardised assessment of their diabetes needs. This was to be achieved using a jointly agreed care pathway involving effective use of an inpatient diabetes specialist team (IPDST). It involved staff education offering appropriate training using adult learning modules, and effective commissioning and planning through good communication between the IPDST, the hospital management and commissioners.
The project was trialled in test sites across the UK and resulted in a 37% improvement in appropriate referrals, a 25% reduction in inappropriate referrals, a 25% increase in early blood glucose testing, a reduction in insulin administration errors by 3 to 1 and a reduction in the average length of hospital stay of at least two days. This saved an average hospital Trust around £1,000,000 per annum.
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