Quality Standards for Diabetes Care Toolkit

Capital & Coast DHB

Capital & Coast DHB/Wellington Diabetes and Endocrinology Service have an agreement with the local ambulance service. This involves notifying the Diabetes and Endocrinology Service when people with diabetes are frequently seen by the ambulance service for diabetes-related callouts – most often as a result of a hypoglycaemia episode.

People with a single ambulance attendance are referred back to their GP.

People with their second or more attendance within one month are referred to the Diabetes and Endocrinology Service.

A three-monthly report is submitted identifying multiple attendances over this time.

These individuals are discussed with the Diabetes Team and seen at an outpatient diabetes clinic if needed (often not previously referred by the Primary Care team).
All children given glucagon in the community are transported to ED for observation, and notification is made to the paediatric team.

Project RED (Re-Engineered Discharge) A re-engineered hospital discharge programme to decrease rehospitalisation: a randomised trial

The RED programme was developed to minimise hospital utilisation after discharge. A set of mutually reinforcing components that define a high quality hospital discharge were created. Components of the RED:

educate the patient about diagnosis throughout the hospital stay

make appointments for follow-up and post-discharge testing, with input from the patient about time and date

discuss with the patient any tests not completed in the hospital

organise post-discharge services

confirm the medication plan

reconcile the discharge plan with national guidelines and critical pathways

review with the patient appropriate steps of what to do if a problem arises

expedite transmission of the discharge summary to clinicians accepting care of the patient

assess the patient’s understanding of this plan

give the patient a written discharge plan

call the patient 2–3 days after discharge to reinforce the discharge plan and help with problem solving.

Intervention: A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualised instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients two to four days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment. Primary outcomes were emergency department visits and hospitalisations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers’ follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment. Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care. The intervention was most effective among participants with hospital utilisation in the six months before index admission. The authors concluded that a package of discharge services reduced hospital utilisation within 30 days of discharge (Jack et al 2009). Project RED describes the programme in more detail. There are other related publications and the RED tools and nurse training manual available for download at no cost. More information can be found here: www.transitionalcare.info/.