Our diabetes service was successful in the application to participate in the RCPCH Quality improvement initiative (20182019).
Our aims were: To identify strategies to enable teams to work collaboratively across multiple trust sites, 30 miles apart, covering a 50 mile radius. To undertake and complete projects in a timely and efficient manner to provide an equitable service across sites. To help maintain consistent improvement in HbA1c outcomes. To implement a programme of continuous education for children and young people with diabetes (CYPD) within the clinic.
To enhance the patient and families clinic experience.
To improve the percentage of care processes completed.
Consistent Information for patients was crucial the team agreed for common goals and targets cross site and trained nursing and medical teams. We reviewed the current clinic situation by providing the previous years PREMS questionnaire and monitored the patient journey in clinic. The clinic environment was altered to save time between various care processes and waiting times were used to provide micro-teaching to patients. All CYPD were handed out All About Me handout which reinforced basics of diabetes management. We started offering CYPD the opportunity to download their glucose meter to diasend in clinic to encourage downloading at home. The number of patients downloading increased from 22 in March to 33 in May 2019. Comparison of random 5 patients who regularly downloaded prior to QI project, compared to 5 patients who never downloaded:
Group 1: Downloading average HBA1C was 56
Group 2: Not downloading average HBA1C was 71
All members of group 2 now downloading over a period of 3 months average HBA1C now 57. We started using HbA1C tracker in clinic notes to monitor trends. One stop annual review clinic was set up to meet multidisciplinary team and undertake care processes. Safe management checklist to keep patient out of hospital was discussed in all annual review clnics.
Reflections: Team had Positive Go for it attitude. QI huddles and Cross site meetings helped strengthen team bonding and boosted morale.
What next?: Consider a virtual clinic. Audit the management of patients a year after diagnosis. The journey continues…
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes