Background

Patients with Diabetes Mellitus (DM) were identified as a group frequently re-presenting to Prince of Wales Hospital Emergency Department. A retrospective audit of healthcare records of patients with diabetes mellitus was conducted to identify characteristics predisposing to re-presentation.

Aim

To identify any commonalities between patients with diabetes re-presenting to the Emergency Department that may be used to predict and avoid future visits to hospital.

Method

A random sample of 26 patients with diabetes (10 males and 16 females) re-presenting to the Emergency Department were identified by using Electronic Medical Record ‘patient flow reports’. Their health care records: information on type and duration of diabetes, time between re-presentations, age, number of co-morbidities, polypharmacy, HbA1c, reason for re-presentation, type of insulin regimen and psycho/social situation were reviewed.

Findings

Often patients were not admitted but were discharged from Emergency Dept. Five patients died. Number of reasons for presentation to hospital: (31), only (5) were for acute diabetes complications. All but 1 patient were on insulin.

Core commonalities seen between patients with diabetes re-presenting to hospital were: poly-pharmacy (medications: aside from insulin injections, 3 to 18) comorbidities (number of comorbidities; 1 to 11), having a carer (but often the care-giving situation was problematic) and poor glycaemic control (HBA1c range; 6.1% (43mmol/L) to 15.3% (143.7mmol/mol)) Importantly, all but two patients had some mental ill health, reduced cognition, developmental delay, substance abuse, brain injury or dementia.

Conclusion

The impact of mental ill health or factors affecting cognitive capacity on a patient’s self-health care management, carer relationships and rate of re-presenting to hospital needs further investigation and potential to review service provision for this group.