'Positive disruption' to diabetes inpatient care due to COVID-19

  • Becky McCall, Medscape.com

  • UK Medical News
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Innovative ways of managing hospital inpatients with diabetes, that could be implemented this coming winter, have been identified as a result of the COVID-19 pandemic says a report by Diabetes UK.

The review, entitled 'Inpatient Diabetes Care during the COVID-19 Pandemic', set out to determine how the pandemic impacted the delivery of care for diabetes patients in UK hospitals.

"We found that disruption to inpatient diabetes services created positive environments and opportunities for new ways of working," write the authors of the report. They point out that, "…the way hospitals re-organised and prioritised inpatient services frequently determined whether clinicians reported a positive or negative experience".

However, in the minority, the disruption impacted on the quality of care clinicians felt they were able to deliver, they add.

'New Normal'

According to a news release from Diabetes UK, the 'new normal' for inpatient care should therefore not involve a move back to old ways of working, but instead be an opportunity for continued prioritisation and recognition of diabetes inpatient care as an integral, governance and safety-led component of hospital care.

In England, the NHS is moving into phase 3 of its response to COVID-19, which requires services to take into account the lessons learned during the first COVID-19 peak, and 'lock in beneficial changes', says the report. To this end, Diabetes UK interviewed healthcare professionals across the UK to find out about their experiences of delivering inpatient diabetes care during the COVID-19 pandemic earlier this year.

Professor Gerry Rayman, clinical lead, Improving Inpatient Care Programme, Diabetes UK, and consultant physician at East Suffolk and North East NHS Foundation Trust, is quoted in the report. He highlights that in some Trusts: "… teams were able to deliver inpatient care in ways not previously possible, including weekend working, as the inpatient diabetes team was bolstered by diabetes staff released from their outpatient or community duties."

The increased presence of diabetes specialists at ward level was valued by other teams, he adds. "The worry is that as people get back to their usual jobs, diabetes services will no longer be able to provide the level of safe care which was possible."

Technology

Some of the common experiences reported include use of technology such as web-linked glucometers, electronic patient records and prescribing, online referral systems, video conferencing tools, and the creation of inpatient diabetes dashboards that were all deemed vital to providing care during the pandemic. The authors note that this technology increased the number of patient reviews and improved patient flow from admission through to discharge, as well as enabling inpatient care by staff unable to attend the bedside.

Importantly, the report also raises the issue that the positive findings with respect to inpatient services were often only possible due to the redeployment of outpatient service staff. The authors write: "Outpatient care is important to help with admission avoidance. COVID-19 has highlighted the fact that diabetes outpatient care needs to be optimised as much as possible. In particular, in the recovery phase with the potential for a second surge.

"It's important for us to provide the best outpatient support to prevent admissions and severe cases of COVID-19."

Based on the findings, the charity makes recommendations that it believes are key to ensuring safe and effective inpatient diabetes care in the months to come. It also hopes such changes will "significantly reduce the strain on those fighting the pandemic from the front lines as winter approaches," says Bridget Turner, director of Policy Campaigns and Improvement at Diabetes UK.

These recommendations are: maintaining or reinstating multi-disciplinary diabetes inpatient teams urgently; involving diabetes specialist teams in the planning of the response to the next phases of the COVID-19 pandemic; actioning the NHS England Long Term Plan commitments to ensure universal coverage of diabetes specialist nurses; maintaining technological advances or putting new systems in place where they have previously been unable to, eg, web-linked glucometers, and video call equipment; with the NHS wanting to accelerate the return to near-normal levels of non-COVID health services, surgical care pathways for people with diabetes must be in place at all sites where surgery is carried out; and prioritising the wellbeing of health care professionals to ensure there is time for rest and recovery. 

Adapted from Medscape UK.