Abstract
It is well established that inpatients with diabetes are associated with poorer clinical outcomes. We therefore investigated the effects of introducing a point-of-care (POC) ward-based glucose and ketones assessment to trigger a diabetes inpatient specialist nurse (DISN) proactive review to the ward, on the length of stay (LOS), 30-day readmission rate and 30-day mortality rate.
Data were extracted for patients admitted to The Royal Derby Hospital during two six-month periods in 2017 (pre-intervention) and 2018 (post-intervention). Data from four acute wards were used in the analysis, including two high dependency units (HDUs), an intensive care unit (ICU) and a medical admissions unit. The following clinical outcome measures were compared between the two groups: average LOS, 30-day readmission rate and 30-day mortality rate. Subgroup analysis was also performed to investigate the clinical outcomes for insulin-treated patients.
In total, 979 patient admissions were included in the study (n=443 in the 2017 pre-intervention; n=536 in the 2018 post-intervention). Thirty-day readmission rates decreased significantly after the introduction of the POC-DISN proactive review (29.3% to 20.1%, p=0.001). However, 30-day mortality rates and the average LOS did not significantly decrease. Subgroup analysis showed that 30-day readmission rates among the three wards (ICU and two HDUs) reduced further for patients using insulin (26.8% to 16.4%, p<0.05) compared to those not using insulin (26.6% to 22.2%, p<0.05).
In conclusion, POC-DISN intervention was effective in reducing 30-day readmission rates for inpatients with diabetes. There was no significant impact on the 30-day mortality rate or average LOS. Patients using insulin as part of their diabetes management were more likely to benefit from this intervention. Copyright (c) 2020 John Wiley & Sons.