Can we prevent hospital admissions for diabetes?
Published Date: 10th May 2017
Publication Authors: Merriman M
Aim
To identify reasons for presentation at the emergency department and identify methods to avoid hospital admission in patients from a single Clinical Commissioning Group (CCG).
Methods
We examined the case records of all patients with diabetes specific emergency admissions from Knowsley CCG area to Aintree University Hospital over a 12 month period.
Results
Fifty-four admissions involving 37 patients were identified (22 Male, 24 Type 1 diabetes, age 18–87 years, mode 24 years). Diabetic ketoacidosis (DKA) (37%) was the commonest cause of admission with six repeated admissions from one patient; followed by infection (18.5%), ketosis (11.1%), gastritis (11.1%), missed insulin causing hyperglycaemia (9.2%), continuous subcutaneous insulin infusion failure (3.7%), and mental health issues (3.3%). Admissions were considered potentially preventable in 11 cases (2 newly diagnosed Type 1 diabetes, 1 newly diagnosed Type 2 diabetes, 1 pump failure, 2 steroid-induced hyperglycaemia, 1 foot ulcer requiring antibiotics, 2 patients transferred from rehabilitation, 2 incidental hyperglycaemia). In these cases advice could have been sought from diabetes specialist nurses (hospital or community based), GP or on-call diabetes consultant. Admissions which may have been difficult to avoid included DKA, hyperglycaemia due to sepsis, gastroparesis, deliberate self-harm and foot ulcers requiring intravenous antibiotics.
Conclusion
A relatively small number of patients with complex needs contribute to a large proportion of admissions. However some admissions are potentially preventable (20%), and people with diabetes and healthcare professionals require ongoing education and information on where to seek advice before attending or referring to emergency departments.
Lim, JZM; Merriman, M; Wallymahmed, ME; Ooi, C. (2017). A3 (P466) Can we prevent hospital admissions for diabetes? A retrospective review of unplanned hospital admissions . Diabetic Medicine. 34 (S1), 6
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