This document is aimed at clinical commissioning groups, health care planners, hospital senior managers, and clinical teams in primary and secondary care. It is an amalgamation of good practice examples where diabetes services have improved, with bed occupancy and costs being reduced. There is a specific focus on elderly, diabetic patients, and other similarly vulnerable groups, and covers primary and secondary care health services.
“About 1 in 6 hospital beds in England are occupied by someone with diabetes”
Bed occupancy
Written on behalf of Diabetes UK, Association of British Clinical Diabetologists, Diabetes Inpatient Specialist Nurses UK Group, Primary Care Diabetes Society, and the Welsh Endocrine and Diabetes Society, this is an important document because according to the National Diabetes Inpatient Audit, “about 1 in 6 hospital beds in England are occupied by someone with diabetes”. So it is of particular relevance to commissioners of diabetic services. Although it is not a guideline, it does refer to best evidence, including NICE guidelines and quality standards throughout.
Effective models
The document looks at the financial implications of commissioning ineffective diabetes services, makes a number of very specific recommendations, covering the following areas:
- Hospital admission and readmission rates and their variability
- Day case surgery
- Commissioning care
- Primary, acute, and specialist care
- Out of hours support
There are some clear and explicit recommendations for commissioners to follow
Recommendations
The recommendations for commissioners include:
- Obtaining benchmarking data to see how your area is comparing to the rest of the nation
- Reviewing existing services and admission figures
- Commissioning a realistic estimate of what are avoidable admissions
- Evaluating the benefits of employing an appropriate number of diabetes inpatient specialist nurses
- Identifying individuals who are frequent readmissions
- As half of diabetic ketoacidosis (DKA) emergency admission rates are people with Type 1 diabetes, think about commissioning a service that will lower the incidence of DKA
- Identifying people at risk of type 1 diabetes who come from dysfunctional families
- Commissioning a diabetes foot care service, informed by NICE guidance
- Making sure there is a diabetes network in your area, led by a clinician
- Developing with the Ambulance Trust, a hypoglycaemia management pathway
- Providing education and training about existing local diabetes guidelines for health professionals
- Providing education to patients about diabetes and foot care, as prevention and good management will reduce admissions
- Helping primary care staff “to deliver best practice care”
- Developing out of hours support for people with diabetes
Amalgamation of good practice examples where diabetes services have improved, with bed occupancy and costs being reduced
Commentary
This document is really useful because it can be used to make the business case for changing and improving clinical service delivery. The recommendations are very clear and explicitly describe what should be done. Within your teams, it would be worth going through each of the recommendations to see if you are already implementing them, whether it is appropriate for you to be implementing them, and if you are not implementing them, thinking about how you can do so, to improve the service delivered to your diabetic patients. This document shows that the benefits will not only apply to the patients but also to the health service as a whole.
Link
Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical teams (PDF)
B Allan, M Sampson
Joint British Diabetes Societies for Inpatient Care
December 2013
Related documents
Best practice for commissioning diabetes services: An integrated care framework (PDF)
