The efficacy of hospital-based interventions in reducing length of stay for inpatients with diabetes

ABSTRACT

Background: People living with diabetes are at increased risk of being admitted to hospital and to stay in hospital longer. With a rising prevalence of diabetes globally and excessive expenditure on this condition, opportunities to reduce length of hospital stay must be prioritised. Aim: This review aims to explore the efficacy of hospital-based interventions (i.e., a clinical interaction in a hospital setting for health-related outcomes) in reducing length of hospital stay for the inpatient with diabetes and describing the findings based on a systematic review of relevant studies. Method: A systematic search of CINAHL, Medline Ovid, Web of Science and SCOPUS databases for research papers relating to adult inpatients with diabetes was conducted for the period 2010–2020. Methodological assessments were undertaken with a narrative synthesis to assess study quality and implement Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria with the population, intervention, comparison, outcome model utilised in the search strategy. Results: Seventeen intervention studies spanning a range of inpatient areas relevant to adults with diabetes examined clinical procedures and treatments (n=8), education of patients and junior doctors (n=2), multidisciplinary teams, diabetes inpatient specialist nurses (n=5) and the use of technology (n=2). The studies demonstrated significant improvements in clinical outcomes including reduction in length of hospital stay. Encouraging results were seen with the introduction of a podiatric foot coordinator position that showed the most significant reduction in length of hospital stay at 10.4 days, closely followed by a diabetic foot ulcer treatment programme that established a reduced length of hospital stay of 9.3 days and a nurse led insulin protocol showed reduced length of hospital stay by 4.1 days. These studies also demonstrated improved clinical outcomes across other parameters including estimated cost savings of £234K, lowered amputation rate, and decreased hypoglycaemia and hyperglycaemia. Similarly, remaining studies determined additional outcomes of increased time in target, high levels of patient satisfaction and postoperative complications significantly decreased. Discussion: This review demonstrates the potential for hospital-based interventions to impact positively on length of stay for adults with diabetes and demonstrates significantly reduced length of hospital stay following a podiatric high-risk foot coordinator position and diabetic foot ulcer treatment programme. Investment in and commissioning of programmes that show significant impact in reducing length of stay and hospital costs should be worthwhile. As the health service rebuilds and recovers from the devastation of COVID-19 the adaptability of the healthcare system is vital for future planning. As length of stay is a key performance indicator, made even more relevant during the pandemic, these results should be a catalyst for nurses and managers with cooperation from organisational management to facilitate translation of such evidence into practice.