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Thursday, 6 October, 2011 - 15:48
Board 1

Length of Stay of Diabetic Inpatients: Benefit of Weekend Ward Rounds Daniel Lake, Laura Korb, Ashutosh Singh, Devaka FernandoDepartment of Endocrinology, King’s Mill Hospital. Sherwood Forest Hospital Trust, Sutton in Ashfield, Nottinghamshire, NG17 4JL Introduction During our foundation year medical rotation we noticed that certain patients under the care of the endocrine team appeared to have greatly delayed discharges. It has been proven that ddiabetic inpatients have longer length of stay (LOS) than non-diabetic patients with the same complaint. This seems most apparent in the 25-64 age group. Research shows increased complication rates in diabetics and these complications are a reason for increased LOS. With regards to LOS, in this current economic climate the financial implications must be considered. NHS institute quoted a bed to be at least 250 pounds sterling a night. Using a return of investment calculator as part of the NHS quality and service improvement tool, one trust reduced length of stay in 20 patients with a secondary diagnosis of diabetes by an average of 2 days. This projected to £250, 000 per annum if only 50% of this patient group reduced their length of stay by this time period. At King’s Mill Hospital (KMH) Mansfield, United Kingdom, endocrine consultant ward-rounds currently take place twice a week. The choice of days for senior input is key to discharge rates especially regarding weekends. It was noticed by both the medical and the nursing staff that weekend discharges hardly ever happened due to on call team pressures. Aims To audit the current length of stay in diabetic patients and to analyse the factors that influence this.  Materials and methods A retrospective audit of 40 patients who were admitted under the care of the Endocrinologists. Our inclusion criterion was the first 40 admissions between August and November 2010 with Diabetes recorded as reason for admission. We analysed notes to document date of admission, discharge, first documentation of plan for discharge in medical and nursing notes using a standardised proforma.Audit Standards     All patients with diabetes, admitted to hospital, for whatever reason, will     receive effective care of their diabetes as stated in NSF Standard 8. All diabetes inpatients who require social input to discharge have appropriate sections instigated within 1 day of team decision and documented in medical and nursing notes. All diabetes inpatients will have clearly documented medically fit for discharge statements Results Out of forty patients, there was a median LOS of 3.5 days     (Inter-quartile range 2-6.5 days) and mean age of 46 years.     The most common reason for admission was DKA. 43% of     patients had documented plans for discharge. There was a     significantly longer LOS for admissions on a Saturday [11.7     Days SD 20.3] in comparison to a weekday [2 Days SD 0]     (p=0.01). Unsurprisingly there were significantly more     discharges on days of consultant ward-rounds [52.5% SD 5.3]     as opposed to non-consultant ward-rounds [47.5% SD 5.4]     (p<0.0001).  Conclusion From our results it can be seen that discharges are peaking at consultant ward rounds causing lengthened stays over weekend periods. We also noted that more diabetic patients are discharged without documented plans for discharge than with.  Diabetic admissions at weekends have longer LOS than during the week, resulting in less efficient care and increased cost to the NHS. Introducing an Endocrine Consultant ward-round on Saturday could possibly reduce the LOS to an equivalent of the weekday LOS, which is a mean reduction of 4.1 days. With Kings Mill Hospital having 10 admissions due to diabetes per week, using the NHS Instiitute bed value, this would be an annual saving of £130,000.  This would most importantly benefit the patients by reducing hospital acquired complications.Future Developments We believe that weekend  endocrine consultant ward rounds would result in earlier discharge of patients admitted at the weekends.  We also would encourage better documentation of discharge planning and discharge meetings to aid in difficult discharges at an earlier point. Once these changes have been implimented we plan to re-audit the change.References Simmons D, Wenzel H. Diabetes inpatients: a case of lose, lose, lose. Is it time to use a 'diabetes-attributable hospitalization cost' to assess the impact of diabetes? Diabet Med. 2011 Mar 18. (PMID:21418095 NHS Institute for Innovation and Improvement 2006-2011, , accessed 20/09/2011Acknowledgments Kings Mill Hospital Endocrine department Audit committee KMH

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