Endocrine Abstracts

Introduction: Daytime support from the diabetes-team reduces pressure on acute services however out-of-hours less support exists and diabetes related attendances to A&E are a potentially avoidable burden on resources. With the introduction of paediatric diabetes best-practice-tariff, recommendations included 24 h access to trained diabetes professionals for patients with known diabetes. In 2013 our three institutions created a consultant led out-of-hours paediatric diabetes support telephone service (OOHS). Its impact on A&E attendances and admissions is shown.

Methods: Diabetes related attendances to A&E out-of-hours and ward-admissions were retrospectively analyzed in the year before and after the implementation of the OOHS. Unavoidable attendances i.e.: first presentation of diabetes, were excluded along with patients not registered with our diabetes service. Dates covered: Evelina: pre-OOHS Feb 2012–Feb 2013, post-OOHS March 2013–March 2014; Lewisham: pre-OOHS Oct 2011–Sept 2012, post-OOHS Feb 2013–March 2014; Kings: pre-OOHS Jan 2012–Dec 2012, post-OOHS; Jan 2013–Dec 2013.

Results: A&E attendances: Evelina: 23 pre-OOHS, 16 post-OOHS (−30%); Lewisham: 28 pre-OOHS, 25 post-OOHS (−11%); King’s: 70 pre-OOHS, 54 post-OOHS (−33%).

Admissions to ward: Evelina: 12 pre-OOHS, 13 post-OOHS (+8%); Lewisham: 3 pre-OHHS, 11 post-OOHS (+266%); King’s: 30 pre-OHHS, 22 post-OOHS (−27%).

Conclusions: Out-of-hours A&E attendances of patients with known diabetes has declined however the effect on admissions is inconsistent. A possible explanation for this is poor patient engagement with the OOHS. Review of Evelina’s cohort who had multiple A&E attendances were found to have poor diabetes control reflected by a high HbA1c and poor compliance with their treatment regimen reflected in clinic letters. One family did not speak English. Thus advocating the use of OOHS more aggressively to these families and providing leaflets advertising it in different languages, may help reduce the numbers of re-attenders presenting in DKA, and thus reducing admissions.