Inpatient perioperative diabetes leads could improve health outcomes
The NHS should consider employing perioperative diabetes leads in all hospitals, according to a new study.
Researchers looking at how to reduce further health issues among those who have diabetes and undergo surgery in hospitals have made a series of recommendations.
The suggestion of perioperative diabetes leads would see them work closely with preoperative assessment teams to ensure appropriate assessment and optimisation of diabetes. Their role would also see them ensuring there is an integrated pathway of care that covers the whole of the patient journey from primary care referral through to preoperative assessment; admission, theatre, recovery, surgical ward, discharge and finally back to the care of primary care.
In addition to perioperative diabetes leads, the research team also suggested surgical diabetes inpatient specialist nurses could also make a positive impact on inpatients.
Their role would include liaising with primary and secondary care to optimise diabetes control and provide continuity of care. Furthermore, they would collect and share audit data, which could be used to improve quality improvement projects within the field of management of surgery among people with diabetes.
The trial was carried out because data has shown that individuals who have diabetes and are admitted to hospital under medical or surgical specialties come to harm and have more complications than those people who are admitted with the same conditions but without having diabetes.
This often leads to extended lengths of stay and increased costs. Furthermore, there is now evidence that complications do not just carry a short-term impact on the mortality and morbidity of people, but that complications have an impact on the length and quality of life-extending for several years after they discharged from hospital.
Professor Ketan Dhatariya, based at the Norfolk & Norwich University Hospitals NHS Foundation Trust, led the research study.
He concluded: “Over the last few years, great progress has been made on identifying the modifiable risk factors that are associated with poor outcomes in the care of the person with diabetes undergoing surgery. The challenge is identifying and promoting the strategies that are now known to be associated with better outcomes, and conversely identifying strategies that are associated with worse outcomes and then eliminating these from practice.
“This will require collaborative work between patient representatives, primary care, diabetologists, surgeons, anaesthetists and nursing staff, and may best be served by the creation of truly multidisciplinary guidelines with each recommendation being assigned an appropriate level of evidence and strength of recommendation.
“This will enable local teams and clinicians to independently judge the strength of each recommendation and enable local adoption. With the recent formation of the Centre for Perioperative Care, there is now the impetus and the mechanisms in place to promote the integration of services that are urgently required to improve the management of the surgical patient with diabetes. While the challenges are large, the rewards are huge in terms of cost savings to the NHS and allowing more patients to experience the benefits of surgery, rather than experiencing adverse outcomes.”