None listed
Conditions
Brief summary
Background: South Western Sydney Local Health District (SWSLHD) is characterised by its rapid population growth and rich cultural diversity, with 36% of the population born overseas. Compared to the rest of Australia, residents in SWSLHD have a higher prevalence of diabetes (6.3%). At the hospitals in SWSLHD, the average length of stay (LOS) for all admissions in 2014 was 3.9 days, while the average LOS was 6.3 days for patients with diabetes as a secondary diagnosis. The increase in LOS translated to an extra 57,470 bed days in 2014 across SWSLHD. Local audits demonstrate that the current model of care for inpatient diabetes management is inadequate, with patients with diabetes having poor glycaemic control during admission, longer LOS and greater risk of morbidity and mortality. The model of an inpatient diabetes team (IPDT) has been advocated based on observational evidence showing benefits in the United Kingdom. The value of such an approach has not been demonstrated in a randomised controlled trial in Australia or elsewhere. Hypothesis: Implementation of inpatient diabetes teams (IPDT) in intervention wards will improve the glycaemic control of patients admitted in hospital and reduce their length of stay. Objective: The objectives of the study are to test whether an inpatient diabetes team (IPDT) that provides routine review of inpatients with diabetes on randomly selected wards compared with “control" (business as usual) wards improves short and medium term clinical outcomes. We propose that an intervention with the IPDT will: 1) improve glycaemic control for inpatients with diabetes 2) reduce LOS, medication error and morbidity of inpatients with diabetes 3) reduce hospitalisation costs for patients with diabetes in SWSLHD 4) reduce early readmission rates for patients with diabetes discharged from hospital
Interventions
Following randomisation, half of the wards (Intervention wards) will receive the Inpatient Diabetes Team (IPDT) model of care over a 24 week period. The model of care on the selected wards will involve a diabetes nurse educator (DNE) visiting the intervention wards every day (on weekdays). Blood glucose will be measured and monitored on the wards as part of routine care by the ward staff. Based on the assessment of the DNE, inpatients with DM will be stratified into 3 groups-
• low risk patients
Following randomisation, half of the wards (Intervention wards) will receive the Inpatient Diabetes Team (IPDT) model of care over a 24 week period. The model of care on the selected wards will involve a diabetes nurse educator (DNE) visiting the intervention wards every day (on weekdays). Blood glucose will be measured and monitored on the wards as part of routine care by the ward staff. Based on the assessment of the DNE, inpatients with DM will be stratified into 3 groups- • low risk patients (BGL within 5-10, not insulin treated) - no further action • intermediate risk patients (some BGL outside of 5-10 in past 24hr, hypos or on insulin therapy) - DNE reviews patient. Referral to endocrinologist or dietitian if considered required • high risk patients (above 50% of BGL outside 5-10, BGL >15 or severe hypoglycaemia <3.0mmol/L) - DNE reviews patient AND referral to endocrinologist. Referral to dietitian if considered required The trial investigators will meet at least once a month with the diabetes nurse educators to ensure the trial protocol is being followed.
Sponsors
South Western Sydney Local Health District
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
ALL patients admitted on the trial wards will be included in the study, unless they meet the exclusion criteria.
Exclusion criteria
- patients directly managed by the endocrinology team - those admitted for pancreatic surgery that develop diabetes post-operatively during that admission
Outcome results
None listed