The InDiGO Project: Colouring outside the lines of conventional inpatient diabetes management — ASN Events
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The InDiGO Project: Colouring outside the lines of conventional inpatient diabetes management (#382)

Justin Bui 1 , Pixie Barrie 1 , Rachael Critchell 1 , P. Gerry Fegan 1
  1. Department of Endocrinology, Fiona Stanley and Fremantle Hospitals, Perth, Western Australia, Australia

Background:

Baseline audit evaluation of inpatient diabetes at our hospitals demonstrated that:

  • More than one-fifth of inpatients have diabetes.
  • Many of these patients did not achieve recommended glycaemic targets as judged by bedside glucose readings
  • Only one third had Hba1c measured.
  • Three- quarters of junior doctors reported not being aware of consistent criteria for specialist diabetes review.
  • Many referrals to the specialist team occurred late in patient admission.

 

Aim:

  1. Undertake a clinical redesign and quality improvement project to address the above issues.
  2. Implement a strategy for early identification, risk stratification and specialist review of in-patients with diabetes.

 

Methods:

Using Define-Measure-Analyse-Improve-Control (DMAIC) methodology, we evaluated the current process of inpatient diabetes management, identified root causes and developed key solutions to benefit patient care. Wide stake holder involvement and engagement was central to process.

The project was carried out across 2 hospital sites: the 783-bed quaternary hospital (Fiona Stanley Hospital) and an associated general hospital (Fremantle Hospital) in Western Australia.

 

Outcomes:

Main outcome was the development and implementation of InDiGO (Inpatient Diabetes & Glucose Optimisation) initiative. This included the development of InDiGO referral guideline (see abbreviated example below) which is being disseminated throughout both hospitals in poster and electronic format. An awareness and education campaign has promoted the InDiGO project. The responding specialist team is known as InDiGO team and we believe adds colour and value to in-patients with diabetes.

Ongoing evaluation of the initiative with outcomes is planned.

 

 

Inpatient Diabetes & Glucose Optimisation (InDiGO) Referral Criteria (Abbreviated version)

  • Type I Diabetes
  • Newly Diagnosed Diabetes
  • Diabetic Emergencies
  • Persistent Hyperglycaemia (BSLs >12mmol/L) with concomitant medical issues
  • Foot Ulceration
  • Pregnancy with Gestational or pre-existing Type I and II diabetes
  • Clinician or Patient concerns
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