title: Management of raised glucose, a clinical decision tool to reduce length of stay of patients with hyperglycaemia.
abstract: OBJECTIVE
  To assess whether the introduction of a management of raised glucose clinical decision tool could improve assessment of patients with hyperglycaemia by non-specialist physicians, leading to early discharge and improved quality of inpatient care.
  
  
  METHODS
  Participants were adults aged 18 years or over presenting to the Medical Assessment Unit with a capillary blood glucose level > 11.1 mmol/l. Phase 1 of the study (phase 1) evaluated current clinical practice and potential impact of the clinical decision tool. Phase 2 evaluated the effectiveness of the management of raised glucose tool in clinical practice. Primary outcome measures were inpatient length of stay and same-calendar-day discharges. Secondary outcome measures were diabetes specialist input, patient assessment, intravenous insulin infusion use and patient satisfaction.
  
  
  RESULTS
  Implementation of the management of raised glucose clinical decision tool allowed safe, same-calendar-day discharges of 40% of patients with hyperglycaemia as their primary reason for attendance. Median length of stay was lower in the phase 1 than in phase 2 (1.0 vs. 3.5 days, P < 0.01). Early discharge did not result in an increase in readmissions. There was improvement in hyperglycaemia assessment for all patients (P < 0.01), a reduction in the use of intravenous insulin infusions (P < 0.01) and high level of patient satisfaction.
  
  
  CONCLUSIONS
  The management of raised glucose clinical decision tool resulted in a significant increase in the number of same-calendar-day discharges and reduction in hospital length of stay without adverse impact on readmission rates. Additionally, the tool was associated with improvements in inpatient diabetes care and patient satisfaction.
authors.affiliation: Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Herring
authors.forename: D L
authors.initials: DL
authors.lastname: Russell-Jones
authors.forename: C
authors.initials: C
authors.lastname: Pengilley
authors.forename: H
authors.initials: H
authors.lastname: Hopkins
authors.forename: B
authors.initials: B
authors.lastname: Tuthill
authors.forename: J
authors.initials: J
authors.lastname: Wright
authors.forename: S V
authors.initials: SV
authors.lastname: Hordern
authors.forename: S
authors.initials: S
authors.lastname: Davidson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D017046:Cost Savings; D003661:Decision Support Techniques; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000191:economics; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000191:economics / Q000628:therapy*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care; D055815:Young Adult
chemical_list: D001786:Blood Glucose