title: Non elective re-admissions to an acute hospital in people with diabetes: Causes and the potential for avoidance. The WICKED project.
abstract: BACKGROUND
  Managing people with diabetes is a health priority worldwide. Cost benefit attempts at avoiding non elective admissions (NEA) have had some success. To develop an NEA avoidance service, we audited multiple NEA in those with diabetes.
  
  
  METHODS
  All people with diabetes who had ≥3 NEA to our hospital over 12 months were identified (n=418); 104 (1 in 4) patients were randomly selected and retrospective data collected in 98 subjects on their index (latest, 3rd) admission.
  
  
  RESULTS
  Of 98 subjects (50 males, 60 Caucasians, 86 type 2 diabetes, aged 69±16 years).Conditions contributing to admission included: Significant co-morbidities in 95 patients (≥2 in 57, ≥4 in 24). Only 14 admission were directly due to diabetes: hypoglycaemia (5); hyperglycaemia (6); DKA (2), Infected foot ulcer (1).97 admissions were justified at the time of presentation. However whilst 78 were unavoidable, 19 were deemed avoidable amongst whom 10 were diabetes related.
  
  
  CONCLUSIONS
  The majority of re-admissions were due to multi-morbidity and were often non-diabetes related. The concept of avoidability must be distinguished from point justification at the time of acute need. This would allow the prospective identification of high risk patients and requires an integrated working process to avoid NEA.
authors: Lea Road Medical Practice, Wolverhampton, UK; Diabetes Centre, New Cross Hospital, Wolverhampton, UK. Electronic address: Syed.gillani@nhs.net.
authors: Syed M R
authors: SM
authors: Gillani
authors: Diabetes Centre, New Cross Hospital, Wolverhampton, UK.
authors: Umaira
authors: U
authors: Aziz
authors: Diabetes Centre, New Cross Hospital, Wolverhampton, UK.
authors: David
authors: D
authors: Blundell
authors: Diabetes Centre, New Cross Hospital, Wolverhampton, UK.
authors: Baldev M
authors: BM
authors: Singh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003695:Delivery of Health Care; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010359:Patient Readmission; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Diabetes care delivery; Non elective admissions