title: Evaluation of a diabetes referral pathway for the management of hypoglycaemia following emergency contact with the ambulance service to a diabetes specialist nurse team.
abstract: OBJECTIVE
  To evaluate the effectiveness of ambulance crew referral of patients treated for acute hypoglycaemia, to a diabetes specialist nurse (DSN) team. Patients were assessed by the ambulance service and did not attend an emergency department.
  
  
  METHODS
  For a 3 month period patients were referred from two areas of West Yorkshire by the ambulance service to specialist diabetes teams. The DSNs contacted the patients within 7 days by telephone and arranged further review if necessary. Satisfaction questionnaires were sent to patients.
  
  
  RESULTS
  Thirty eight patients were referred and all were reviewed by telephone; 30 (79%) also required a clinic review appointment. Warning signs of hypoglycaemia were identified by 21 (55%) patients, but 14 (37%) had none (three had incomplete data). Twelve patients had had a self-treated episode in the previous 6 months; nine patients had had three or more. Fifteen (39%) patients had called an emergency ambulance for similar reasons in the previous 6 months (27 "999" calls). Twenty patients (53%) had their drug treatment altered at a clinic appointment and 14 (37%) required ongoing review. Twenty six patients returned the satisfaction questionnaire; of these 88% agreed or strongly agreed that they had improved their understanding of hypoglycaemia and 73% felt more able to treat a hypoglycaemic episode in the future. Patient satisfaction with this care pathway was high.
  
  
  CONCLUSIONS
  The ambulance service can coordinate successful referral of patients with episodes of acute hypoglycaemia to a DSN-led service. Patients often required treatment review. They valued this service and felt more confident managing their diabetes.
authors.affiliation: Mid Yorkshire Trust and West Yorkshire Metropolitan Ambulance Service, Wakefield, UK. alison.walker@wymas.nhs.uk
authors.forename: A
authors.initials: A
authors.lastname: Walker
authors.forename: C
authors.initials: C
authors.lastname: James
authors.forename: M
authors.initials: M
authors.lastname: Bannister
authors.forename: E
authors.initials: E
authors.lastname: Jobes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards; D003920:Diabetes Mellitus / Q000451:nursing*; D004631:Emergency Medical Service Communication Systems / Q000592:standards; D004632:Emergency Medical Services / Q000592:standards*; D004739:England; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000451:nursing*; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians; D017060:Patient Satisfaction; D012017:Referral and Consultation / Q000592:standards*; D011795:Surveys and Questionnaires