Briefing note: Inpatient care for people with diabetes
Inpatient care for people with diabetes is one of eight areas of healthcare being
tackled in by the NHS Institute for Innovation and Improvement (NHS Institute)
because the care provided varies in quality and efficiency across England. The
initiative is part of Phase Two of the High Volume Care programme from the
Delivering Quality and Value Team at the NHS Institute.
The NHS Institute was established in 2005. It aims to support the NHS with high
impact solutions to some of its biggest challenges, as well as innovative ideas, new
practices and technologies that will really make a difference to the delivery of patient
care. The mission of the NHS Institute for Innovation and Improvement is to improve
health outcomes and raise the quality of delivery in the NHS by accelerating the
uptake of proven innovation and improvements in healthcare delivery models and
processes, medical products and devices and healthcare leadership.
High volume care groups are clinically similar activities for which a similar quantity of
resources is needed.
One in ten inpatients in the UK has known diabetes. There are large variations in the
length of stay for these patients between different hospitals and variations in the time
those with and without diabetes spend in hospital.
These variations suggest that;
• some hospitals may be doing certain things to maximise care and minimise length
of stay for these patients;
• and that other hospitals may be able to learn from this to improve the quality and
value of their own services and pathways. In particular we want to focus on those
patients who are admitted for routine elective (planned) treatment, such as day case
surgery or hip replacement surgery, and those who are admitted in an emergency
(unplanned) with a range of cardiac conditions. While the project complements the
work of the National Diabetes Support Team and others working in this area, it is also
allowing us to focus on an important pathway that has not previously been looked at
on a national level for this group of patients.
There are also inconsistencies in the care provided whilst these patients are in
hospital. In a national survey of people with the condition, the Healthcare
Commission found that more than thirty per cent of people reported that staff were
unaware of their diabetes and one in ten had no help with it whilst in hospital1
Inpatient care for people with diabetes is one of eight healthcare improvement
initiatives in the second phase of the NHS Institute’s Focus on: High Volume Care
Programme and is based upon 12 months of clinically-led work.
The NHS Institute is committed to co-producing products with frontline NHS staff. We
use clinicians and managers from inside the NHS to work with us as part of our
project team and work closely with a range of NHS staff and organisations to ensure
that the people who we want to use our products are able to influence their design as
much as possible.
The team chose a small number of hospitals to visit based on high level data relating
to length of stay for people with diabetes to talk with staff, observe practice
and identify ideas and themes for practical tools and resources that will help NHS
organisations improve the care pathway for this group of patients.
These sites are also hospitals that are keen to learn from the work to further improve
the care they offer patients with diabetes and provide planned and emergency
inpatient care to people with diabetes. Working with frontline staff and more than 100
stakeholders from a range of groups, they created optimised pathways for inpatients
with diabetes and identified the principles and characteristics that hospitals need to
adopt in order to improve quality of care and efficiency.
Stakeholders involved in the work included; Diabetes UK, the National Diabetes
Support Team, the Department of Health and representatives of the inpatient
diabetes community and ambulance services.
Some of the ‘good practice’ case studies that have been identified include;

A pathway of pre-operative assessment and care planning for people with
diabetes that has been developed by a multi-disciplinary team at Bolton
Hospitals NHS Trust and Bolton PCT;
1
Department of Health Improving diabetes care for inpatients working group, (2008), ‘Improving emergency and in hospital care for people with diabetes.’

Diabetes ‘resource boxes’ made available at nurses’ stations on wards in
Northampton General Hospital NHS Trust;

A guideline for the management of hyperglycaemia in the context of
suspected acute coronary syndrome that has been introduced at Oxford
Radcliffe Hospitals NHS Trust;

A hospital-based specialist walk-in diabetes clinic in North West London run
jointly by Brent PCT, together with The North West London Hospitals NHS
Trust;

A rolling programme of specialist training support for individual wards at the
Royal Bournemouth and Christchurch Hospitals NHS Trust.
The NHS Institute team has produced a document outlining the work and are also
developing a range of products that capture this good practice and will help NHS staff
improve patient care and in turn, increase efficiency.
The products under development are aimed at helping clinicians and managers
implement the key characteristics of good care organisation and delivery. It is
expected that by the end of May 2008, the products available will include:

‘Think Glucose’ packs to raise awareness throughout hospitals of glucose
management.

A tool to help staff and patients agree on ability and desire to self-manage
their diabetes care whilst in hospital.

A tool to help specialist diabetes teams make a business case for
improvements to senior hospital managers and commissioners.
During their work, the NHS Institute team engaged with a wide range of clinical and
managerial professionals to ensure the resultant guides would integrate with other
NHS initiatives. The organisations visited as part of the inpatient care for people with
diabetes were; Bolton PCT and Bolton Hospital NHS Trust; Northampton General
Hospital NHS Trust; Oxford Radcliffe Hospitals NHS Trust; Royal Bournemouth and
Christchurch Hospitals NHS Trust; the North West London Hospitals NHS Trust;
University of Leicester NHS Trust; Cincinnati Children’s Hospital Medical Centre
(USA); Denver Health (USA); Hackensack University Medical Centre (USA).
The team also worked closely with several other stakeholders; Department of Health
Policy Team; Diabetes UK; National Diabetes Support Team; The Diabetes Steering
Group on Inpatient Care and Emergency Care; The Ipswich Hospital NHS Trust.
A full copy of the Focus on: High Volume Care report is available to download from
03/03/08 at: www.institute.nhs.uk/diabetes