Improving the outcomes for people with diabetes undergoing surgery: An observational study of the Improving the Peri-operative Pathway of People with Diabetes (IP3D) intervention.

AIMS: We evaluated the effectiveness of an intervention to improve the care of people with diabetes undergoing surgery when implemented across multiple organisations. METHODS: This was an observational study using routinely collected data. Eight hospitals in England implemented the Improving the Peri-operative Pathway of People with Diabetes (IP3D) intervention, with pre-implementation data collected from 1st February to 31st July 2019 and post-implementation data collection within the period 1st February to 31st October 2021. Key elements were the use of a patient empowering peri-operative passport and the employment of a peri-operative diabetes specialist nurse. The primary outcome was the change in length of stay. RESULTS: In total 1837 patients at pre-implementation and 1164 patients at post-implementation undergoing elective surgery were included. Pre- and post-implementation 23.8 % and 33.4 % of patients had day-case surgery respectively. For in-patients median length of stay decreased from 3.2 days (inter-quartile range 1.5-6.1) pre-implementation to 2.5 days (inter-quartile range 1.4-5.4) post-implementation. There were also significant improvements in patient experience, hypo- and hyper-glycaemic events, wound complications and diabetes related complications. CONCLUSIONS: The IP3D intervention has the potential to increase efficiency and reduce waiting lists for elective surgery on a nationwide basis.

Proximal humerus fracture rehabilitation.

UNLABELLED: The occurrence of proximal humerus fractures will continue to rise with the increasing elderly population. Many patients with proximal humerus fractures have osteoporosis and have poor neuromuscular control mechanisms. This predisposes them to future falls and additional fractures. Patients continue to have shoulder problems as a result of the fracture for many years after the injury. Rehabilitation is central to addressing the problems caused by the fracture. The review of the literature on proximal humerus rehabilitation suggests that treatment must begin immediately if the harmful effects of immobilization are to be avoided. Electrotherapy or hydrotherapy does not enhance recovery and joint mobilization has limited evidence of its efficacy. In the United Kingdom most patients are immobilized routinely for 3 weeks or longer and are referred for physical therapy. The best available evidence for shoulder rehabilitation emphasizes using advice, exercise, and mobilization of limited joints to restore upper limb function. Placing controlled stresses throughout the fracture site at an early stage will optimize bone repair without increasing complication rates. This approach requires cooperation between the referring surgeon and therapist and will optimize the patient's shoulder function and maintain their functional independence. LEVEL OF EVIDENCE: Diagnostic study, level II (systematic review of level II studies). See the Guidelines for Authors for a complete description of levels of evidence.