Management of raised glucose, a clinical decision tool to reduce length of stay of patients with hyperglycaemia

• Published in: Diabetic medicine 2013-01, Vol.30 (1), p.81-87
• Main Authors: Herring, R., Russell-Jones, D. L., Pengilley, C., Hopkins, H., Tuthill, B., Wright, J., Hordern, S. V., Davidson, S.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Blood Glucose - metabolism; Calendars; Clinical medicine; Cost Savings; Decision Support Techniques; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - economics; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - economics; Endocrinopathies; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Hospitals; Humans; Hyperglycemia - blood; Hyperglycemia - economics; Hyperglycemia - therapy; Length of Stay - economics; Length of Stay - statistics & numerical data; Medical sciences; Middle Aged; Patient Satisfaction; Quality of Health Care; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Young Adult
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12006

Diabet. Med. 30, 81–87 (2013) Objective  To assess whether the introduction of a management of raised glucose clinical decision tool could improve assessment of patients with hyperglycaemia by non‐specialist physicians, leading to early discharge and improved quality of inpatient care. Methods  Participants were adults aged 18 years or over presenting to the Medical Assessment Unit with a capillary blood glucose level > 11.1 mmol/l. Phase 1 of the study (phase 1) evaluated current clinical practice and potential impact of the clinical decision tool. Phase 2 evaluated the effectiveness of the management of raised glucose tool in clinical practice. Primary outcome measures were inpatient length of stay and same‐calendar‐day discharges. Secondary outcome measures were diabetes specialist input, patient assessment, intravenous insulin infusion use and patient satisfaction. Results  Implementation of the management of raised glucose clinical decision tool allowed safe, same‐calendar‐day discharges of 40% of patients with hyperglycaemia as their primary reason for attendance. Median length of stay was lower in the phase 1 than in phase 2 (1.0 vs. 3.5 days, P