Background: Prior to August 2012, hospitalisation was common for children with diabetes in Flinders Medical Centre who were newly diagnosed; commencing pump therapy or suffering an acute hypo- or hyperglycaemic event. For routine care, the stress of diabetes for some children and their families is increased by long distances to the hospital, inconvenient clinic hours and difficulty parking. A desire to better meet the needs of children and their families and a health department directive to reduce potentially preventable admissions and outpatient services, led to a review of current practice.
Intervention: A paediatric diabetes clinical practice consultant (CPC) was recruited to lead the review and service revision. Hospital avoidance opportunities were addressed by increasing access to after-hours expert assistance; introduction of home visitation by the CPC to provide more intense follow-up of frequent attenders to Emergency Departments (ED) and non-attenders to clinic, and initiation of insulin pump therapy. Partnering with ED and diabetes centre staff, and the provision for home education, has enabled increased discharge directly from ED and earlier discharge following diagnosis for appropriate families. Difficulties accessing hospital services have been overcome by the redeployment of interdisciplinary, extended hours outreach services to primary health sites.
Results: Before and after comparison of the service remodeling and CPC outreach role show reductions of 39% in average length of stay; 17% in ED presentations and 30% in multiple presentations to ED, with no unplanned return to hospital for those managed outside of hospital. In a small sample, 99% of families surveyed answered ‘agree’ or ‘strongly agree’ to a series of seven questions regarding the value of the service with regard to increased convenience and confidence in managing diabetes, and when to seek medical assistance.
Conclusion: The outreach model demonstrates that early intervention, home visitation and consumer focused services can reduce burdens on the health system and increase patient satisfaction in a safe and effective manner.