Background
Far North Queensland has a high Indigenous population, and a high burden of type 2 diabetes 1. Many patients live in rural and remote communities and may not access routine care for chronic disease. Therefore, every opportunity for preventative health should be taken. Hospital admissions are a golden opportunity to intervene. We aimed to document the assessment of patients with diabetes during hospital admission and highlight areas for improvement.
Methods
All inpatients with diabetes in Cairns hospital on two random days in March 2014 were identified via the patient registration system (HBCIS). We excluded gestational diabetes mellitus, paediatrics, patients in the dialysis unit, and those with incomplete inpatient records. Information was obtained from the current admission notes in the electronic medical record, and the hospital pathology system from the last 12 months. We used a standardized data collection form (ANDA-AQCA 2013 form) 2. If patients were admitted twice, only one admission was counted.
Results
87 patients were included in the audit. 36.78% were Indigenous. 91.95% had type 2 diabetes mellitus. Microvascular complications were poorly recorded. 93.10% had no documentation about ophthalmology review. Peripheral neuropathy and proteinuria were not documented in 73.56% and 83.91% respectively. Macrovascular complications such as stroke, myocardial infarction, and peripheral vascular disease were not documented in 58.62%, 56.32%, and 80.46% respectively. Only 1 male had mention of erectile dysfunction. There was no documentation of HbA1C in 44.83%, or lipids in 81.61%. There was no statistically significant difference between surgical and medical teams.
Conclusions
Hospital admissions are a missed opportunity to measure glycaemic control and assess for diabetic complications. Unfortunately these results have not improved compared to an audit from 1998 3. Proposed strategies to improve assessment of diabetic inpatients include implementation of a checklist for medical officers, regular education sessions, and a dedicated inpatient diabetes educator.