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An integrated diabetes service facilitates the transition from inpatient to outpatient and is associated with reduced readmissions

Whyte, MB, Nobel-Bell, G, Boerkamp, M and Malik, R (2014) An integrated diabetes service facilitates the transition from inpatient to outpatient and is associated with reduced readmissions In: Diabetes UK Annual Professional Conference, 2014-03-05 - 2014-03-07, Arena and Convention Centre, Liverpool, UK.

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Abstract

Aims: Patients with diabetes have high risk of readmission following discharge. International standards of care include follow-up within 1 month for patients with in-hospital dysglycaemia. We reviewed our urban tertiary care hospital service that provides diabetes care from admission through to clinic review 1 month post discharge. Methods: All emergency admissions are reviewed on day 1 on the medical assessment unit for the presence of diabetes and/or hyperglycaemia. An electronic referral system was established for other wards. Management and education was delivered on the ward, reinforced where necessary via telephone and reviewed at a dedicated discharge clinic (DC) within 1 month of discharge. Results: Over 12 months 199 new referrals were seen at DC; 52 did not attend (21%); 16% Type 1 diabetes, 60% Type 2 diabetes, 14% ketosis-prone diabetes, 10% other. Median (IQR) time from discharge to DC was 28 (21 45) days. 97 (49%) received telephone advice between discharge and DC. From clinic, 30% discharged to primary care, 42% secondary care follow-up, 28% further review at DC. 147 (74%) had inpatient HbA1c measured; HbA1c dropped from 11.7% to 9.2% at DC (p < 0.001) in those with inpatient HbA1c ≥7.5%. Three of 199 (1.5%) patients attending DC were readmitted within 6 months with diabetes destabilisation vs four of 51 (7.8%) who did not attend the DC (p = 0.03). The magnitude of fall in HbA1c between admission and DC was associated with reduced risk of all-cause readmission (p = 0.02) but not the absolute HbA1c (either as inpatient or at DC). Conclusions: For patients who demonstrate poor inpatient control, a package of care that continues after discharge may help reduce all-cause and diabetes-specific readmission.

Item Type: Conference or Workshop Item (Conference Poster)
Subjects : Nutrition
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine > Department of Nutritional Sciences
Authors :
AuthorsEmailORCID
Whyte, MBUNSPECIFIEDUNSPECIFIED
Nobel-Bell, GUNSPECIFIEDUNSPECIFIED
Boerkamp, MUNSPECIFIEDUNSPECIFIED
Malik, RUNSPECIFIEDUNSPECIFIED
Date : 5 March 2014
Identification Number : https://doi.org/10.1111/dme.12378_2
Copyright Disclaimer : © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK
Depositing User : Symplectic Elements
Date Deposited : 19 Oct 2016 12:51
Last Modified : 19 Oct 2016 13:11
URI: http://epubs.surrey.ac.uk/id/eprint/812510

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