The Diabetes Inpatient Care and Education (DICE) project was planned to reduce harm to patients with diabetes in Ipswich Hospital by establishing a fully-staffed, proactive inpatient diabetes team focused on improving care through innovation and implementation of new systems of care. These aimed to increase specialist surveillance of patients with diabetes, improve staff knowledge and awareness of the condition and evaluate its effectiveness by continuous audit. Innovative strategies and tools included an admission avoidance service, algorithms for admission units, the DICE Care Pathway, an innovative referral system (the Diabetes Patient At Risk score), use of web-connected blood glucose monitors, strategies to prevent nocturnal hypoglycaemia, a junior doctor induction programme and a foot protection pathway. Overall, hypoglycaemic rates reduced by 25% but severe hypoglycaemia fell by 46%.
The National Diabetes Inpatient Audit (NaDIA) found that people with diabetes frequently experience poor care resulting in unsatisfactory outcomes, there is little investment in inpatient diabetes teams and length of stay has not altered. Although most diabetes specialists believe that inpatient diabetes teams improve care, funders do not appear convinced. The DICE project aims to provide as much evidence as possible to support the statement that ‘every hospital should have a fully staffed inpatient diabetes team’.
To improve inpatient diabetes care across a whole organisation and to evidence this by establishing an innovative inpatient diabetes team. To make an in-depth study of the whole pathway of care from admission to discharge, creating strategies and tools to address the observed deficiencies and barriers.
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