Quality Improvement Project: Improving our diabetic specialist referral-form in Princess of Wales Hospital, Bridgend in response to covid-19 pressures

ABSTRACT

Aims: • Covid-19 infection is associated with new-onset diabetes and worse glucose control in pre-existing diabetes. • During the pandemic, our hospital experienced a rise in diabetic specialist-nurse (DSN) referrals similar to across the UK. • The existing DSN referral-form was time-consuming to complete and difficult to interpret. A new form was created to facilitate earlier DSN involvement to reduce delays in treatment. Methods: • The new form was piloted on 3 hospital wards. • The completion of 10 factors (addressograph, location, type of diabetes, referral reason, oral intake, HbA1c, e-GFR, oral and injectable diabetes medication and referrer details) were compared between 25 old and 25 new forms. • Data were analysed using SPSS 27. Results: New forms demonstrated significantly higher completion of 4 parameters compared to old forms location (96% vs. 76%, p = 0.01), type of diabetes (92% vs. 32%, p < 0.001), e-GFR (60% vs. 16%, p = 0.001), referrer details (100% vs. 44%, p < 0.001). A positive trend was identified for oral intake (52% vs. 48%), HbA1c (40% vs. 20%), oral diabetes medication (56% vs. 48%), injectable diabetes medications (88% vs. 72%) when comparing new vs. old forms respectively. Referral reason was completed in 88% of new forms and 96% of old forms. All forms had an addressograph. Conclusions: The new referral-form improved documentation of factors required to effectively prioritise patients. We aim to distribute the form across our hospital wards. Future work will focus on educating clinicians regarding indications for DSN input and importance of biochemical parameters to guide choice of hypoglycaemic agents.