Background: Guidelines on standards for diabetes care for children with type 1 diabetes (TID) recommend continuous (24 h/7-day-a-week) access to advice from specialist health-care professionals. However, for many diabetes teams, limited resources precludes provision of this service outside normal working hours. The use of regional networks may enable the implementation of safe, high quality and cost-effective support to patients and families out of hours.
Methods: A prospective 16 week pilot study including five paediatric diabetes centres (n=965 TID patients, 15% CSII) located in the East of England. Out of hours (17000900 h & weekends) telephone advice for patients was delivered by a team of paediatric diabetes health care professionals (seven clinicians, seven nurse specialists). Advice was given using standardised management algorithms. Calls were logged, and data collected on type / nature of query, advice given and outcome data including hospital attendance and patient satisfaction. Health economic analyses were also performed.
Results: One hundred and ninety-three calls were received from 99 patients (n=51M. n=21 CSII). Median (range) age 9 (217) years. Distribution of calls by centre ranged from 12 to 28%. 50.5% of calls occurred between 1700 and 2100 h (21002300 h (14.6%), 23000700 h (5.2%); 07000900 h (11.7%), 09001700 h (18.%)). Median duration of calls was 9 (range 125) min. Reasons for contact were, CSII queries (23%); hyperglycaemia (21.0%), ketonaemia (13%), hypoglycaemia (11%), vomiting (10%), insulin dose errors (6%) and other diabetes related issues (22%). Four calls (2%) resulted in a subsequent emergency hospital attendance. 63 hospital attendances were avoided, with estimated saving of 35.7 in-patient bed days and cost savings of £23K. Mean (S.D.) patient/family satisfaction score (1= poor, 10= high) was 9.7 (0.7).
Conclusion: Safe and effective telephone advice can be delivered out of hours by sharing resources and experience across an established clinical diabetes network with significant cost savings and high patient satisfaction.
09 - 11 Nov 2011
British Society for Paediatric Endocrinology and Diabetes