Management of raised glucose, a clinical decision tool to reduce length of stay of patients with hyperglycaemia

Herring, Roselle; Russell‐Jones, David; Pengilley, C.; Hopkins, Helen; Tuthill, Beverly; Wright, Jeremy; Hordern, S V M; Davidson, Sue

doi:10.1111/dme.12006

Cited by 7 publications

(12 citation statements)

References 10 publications

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“…l Engagement in audit / research / service improvement: clinical research was generally considered an extracurricular activity, but 24% of responders had experience of clinical research, even fewer (14%) had been involved in service improvement (e.g. introducing a diabetes admissions avoidance plan 10 or an insulin safety group 11 ), but 82% had undertaken obligatory audits. It is noteworthy that several trainees (49%) were pursuing additional qualifications (Figure 4).…”

Section: General Internal Medicine Diabetes Endocrinologymentioning

confidence: 99%

YDEF training survey 2014

Grant¹,

Chakera²,

Cheer³

et al. 2014

Br J Diabetes

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Section: General Internal Medicine Diabetes Endocrinologymentioning

confidence: 99%

YDEF training survey 2014

Grant¹,

Chakera²,

Cheer³

et al. 2014

Br J Diabetes

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“…Change in healthcare cost attributable to the intervention was reported in 15 studies: 13(16–25, 28, 37, 38) EHR-based implementations, one(30) registry-based, and one(32, 33) reporting both types (Table 3). Interventions in addition to the CDSS were present in several studies; therefore, the effect on healthcare cost and other outcomes cannot be attributed to CDSS alone.…”

Section: Resultsmentioning

confidence: 99%

“…Interventions in addition to the CDSS were present in several studies; therefore, the effect on healthcare cost and other outcomes cannot be attributed to CDSS alone. This is especially the case where intensive interventions were added, as for four CDSS interventions that included team-based care,(18, 24, 28, 38) followed by those that added less-intensive interventions, such as quality improvement,(37) provider incentives,(22) provider audit and feedback,(21) and patient reminders. (20, 32, 33)…”

Section: Resultsmentioning

confidence: 99%

Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review

Jacob

Thota

Chattopadhyay

et al. 2017

Journal of the American Medical Informatics Association

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Objective This review evaluates costs and benefits associated with acquiring, implementing, and operating clinical decision support systems (CDSS) to prevent cardiovascular disease (CVD). Materials and Methods Methods developed for The Community Guide were used to review CDSS literature covering the period from January 1976 to October 2015. Twenty-one studies were identified for inclusion. Results It was difficult to draw a meaningful estimate for the cost of acquiring and operating CDSS to prevent CVD from the available studies (n=12) due to considerable heterogeneity. Several studies (n=11) indicated healthcare costs were averted by using CDSS but many were partial assessments that did not consider all components of healthcare. Four cost-benefit studies reached conflicting conclusions about the net benefit of CDSS based on incomplete assessments of costs and benefits. Three cost-utility studies indicated inconsistent conclusions regarding cost-effectiveness based on a conservative $50,000 threshold. Discussion Intervention costs were not negligible but specific estimates were not derived because of the heterogeneity of implementation and reporting metrics. Expected economic benefits from averted healthcare cost could not be determined with confidence because many studies did not fully account for all components of healthcare. Conclusion We were unable to conclude whether CDSS for CVD prevention is either cost-beneficial or cost effective. Several evidence gaps are identified, most prominently the lack of information about major drivers of cost and benefit; the lack of standard metrics for the cost of CDSS; and not allowing for useful life of CDSS that generally extends beyond one accounting period.

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“…Additional training and protocols may be needed for EMTs and paramedics in cases of high blood glucose where treatment is likely to be more challenging. Point of care ketone measurement may be one way of improving outcomes in cases of hyperglycaemia, providing a means of ruling out ketoacidosis at the scene 22 . Continuous or flash glucose monitoring may also be an option to explore for remote observation of glucose levels so more people can be safely left at home 10 .…”

Section: Discussionmentioning

confidence: 99%

Factors influencing hospital conveyance following ambulance attendance for people with diabetes: A retrospective observational study

Woerden

Bucholc

Coldron³

et al. 2020

Diabet Med

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Aim To assess variables contributing to hospital conveyance for people with diabetes and the interactions between them. A secondary aim was to generate hypotheses for further research into interventions that might reduce avoidable hospital admissions. Methods A national retrospective data set including 30 999 diabetes‐related callouts from the Scottish Ambulance Service was utilized covering a 5‐year period between 2013 and 2017. The relationship between diabetes‐related hospital conveyance and seven potential risk factors was analysed. Independent variables included: age, gender, deprivation, paramedic attendance, treatment at the scene, first blood glucose measurement and day of the week. Results In Scotland, hyperglycaemia was associated with a higher number of people being conveyed to hospital than hypoglycaemia (49.8% with high blood glucose vs. 39.3% with low glucose, P ≤ 0.0001). Treatment provided in pre‐hospital care was associated with reduced conveyance rates (47.3% vs. 58.2% where treatment was not administered, P ≤ 0.0001). Paramedic attendance was also associated with reduced conveyance to hospital (51.4% vs. 59.5% where paramedic was not present, P ≤ 0.0001). Paramedic attendance in hyperglycaemic cases was associated with significantly reduced odds of conveyance (odds ratio 0.52, P ≤ 0.001). Conclusions A higher rate of conveyance associated with hyperglycaemic cases indicates a need for more resources, education and training in this area. Higher conveyance rates were also associated with no paramedic being present and no treatment being administered. This suggests that paramedic attendance may be crucial in reducing avoidable admissions. Developing and validating protocols for pre‐hospital services and treatment may help to reduce hospital conveyance rates.

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Management of raised glucose, a clinical decision tool to reduce length of stay of patients with hyperglycaemia

Cited by 7 publications

References 10 publications

YDEF training survey 2014

YDEF training survey 2014

Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review

Factors influencing hospital conveyance following ambulance attendance for people with diabetes: A retrospective observational study

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