Novel Pathway for Ambulance Crew Halves Hypoglycemia Admissions

Liam Davenport

March 24, 2015

LONDON — A novel interdisciplinary care pathway in which UK paramedics were trained to direct the majority of diabetes patients with hypoglycemia to community diabetes services rather than taking them to the hospital improved patient care and reduced costs.

The research was presented at the Diabetes UK Professional Conference, held in London on March 11–13.

The ambulance personnel in West Hampshire were instructed to take patients to the hospital only when absolutely necessary, explained Emily Perry, a diabetes specialist nurse at West Hampshire Community Diabetes Service, Southern Health NHS Foundation Trust, Lyndhurst, United Kingdom.

"The one side of it was improving patient care. The other side of it was reducing callouts, reducing conveyances to the hospital, and therefore [generating] a huge cost reduction. The potential is huge," she observed.

Study Details

Working with their local ambulance service, Ms Perry and colleagues developed a pathway that provided crews attending diabetes patients experiencing a hypoglycemic episode with a simple way to refer patients who were safe to be left at home to their community diabetes specialist team. The team would then contact the patient within 24 hours to offer a telephone assessment.

Paramedics were given a 1-hour hypoglycemia clinical update to improve their knowledge and clinical practice, which resulted in 79 staff being trained from eight of 12 teams in the area.

At all times, hypoglycemia assessment was driven by established protocols and included establishment of the cause of the episode and risk factors and a discussion of prevention strategies. A care plan was then agreed on with the patient and follow-up appointments arranged.

After the introduction of the pathway, 23% of 291 patients experiencing a hypoglycemic episode were referred to the community diabetes specialist team. Just 12% of patients were taken to the hospital, down from 40% before the pathway was introduced.

The majority (84%) of patients were taking insulin, and 56% required only oral glucose treatment. The most common causes of hypoglycemia were too much insulin and not enough food, in 44% and 23% of patients, respectively.

Interestingly, 43% of patients had had a previous ambulance callout for hypoglycemia in the past 12 months.

Ms Perry noted that, as well as improved access to specialist diabetes services and a reduction in the rate of patients being taken to the hospital, the introduction of the pathway improved paramedic knowledge and strengthened interprofessional relationships.

The data the ambulance personnel collected included patient's blood glucose level, symptoms, treatment received on the scene, current diabetes therapy, cause of hypoglycemia, and whether the patient was conveyed to the hospital.

The initial 6-month program was funded by a pharmaceutical company, she said, and the costs incurred were roughly £2000 to get it up and running and to cover the education for the paramedics.

With over 40% of the patients having already accessed ambulance care in the past year, this work shows there is potential to prevent future episodes of hypoglycemia with early referral, assessment, and care planning, Ms Perry concluded.

Diabetes UK Professional Conference. March 13, 2015; London, United Kingdom. Abstracts A63–A68.

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