Survey on transition from inpatient to outpatient for patients on insulin: what really goes on at home?
OBJECTIVE
To identify the diabetes-specific, posthospital discharge issues that may arise for patients sent home on insulin therapy.


METHODS
We designed and conducted a telephone survey covering predischarge issues such as survival skill education and insulin discharge instructions, postdischarge logistical problems such as obtaining diabetes medications and supplies, and overall glucose control. The questionnaire was administered by telephone 1 week after discharge from the hospital to adult patients sent home on long-acting insulin.


RESULTS
We attempted to contact 61 patients who were eligible for the study. Eleven patients were unable to be reached by telephone despite multiple attempts. Forty-seven of 50 patients contacted agreed to be interviewed. Nearly 100% of patients received appropriate "survival skills" training, including instruction regarding self-monitoring of blood glucose, insulin administration, and treatment of hypoglycemia. Once discharged, 10 patients (21%) had difficulty obtaining diabetes medications and supplies. Thirty-seven patients (79%) felt that their blood glucose control was "good" in the week after they left the hospital compared with author perception of 25 patients having good glucose control (53%) on the basis of pre-defined criteria. Although patients received instruction on insulin dosing and when and who to call for problems and questions, specific guidelines on how to manage insulin in the setting of changing glucocorticoid dosages were not communicated to patients.


CONCLUSIONS
On the basis of our findings, we anticipate implementing improvements in diabetes-specific discharge prescriptions, new guidelines on when patients should call for assistance, and specific orders on how to adjust insulin for changes in glucocorticoid dosages.
Kimmel
Bonnie
B
Division of Endocrinology and Metabolism, University of California-San Francisco, San Francisco, California 94115 , USA.
Sullivan
Mary M
MM
Rushakoff
Robert J
RJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D003625:Data Collection; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006699:Home Care Services / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007297:Inpatients / Q000706:statistics & numerical data; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data
D007004:Hypoglycemic Agents; D007328:Insulin