Improving the outcomes for people with diabetes undergoing surgery: An observational study of the Improving the peri-operative pathway of people with diabetes (IP3D) intervention

Abstract

AimsWe evaluated the effectiveness of an intervention to improve the care of people with diabetes undergoing surgery when implemented across multiple organisations. MethodsThis was an observational study using routinely collected data. Eight hospitals in England implemented the Improving the Peri-operative Pathway of People with Diabetes (IP3D), with pre-implementation data collected from 1st February to 31st July 2019 and post-implementation data collection within the period 1st February to 31st October 2021. Key elements were the use of a patient empowering peri-operative passport and the employment of a peri-operative diabetes specialist nurse. The primary outcome was the change in length of stay. ResultsIn total 1837 patients at pre-implementation and 1164 patients at post-implementation undergoing elective surgery were included. Pre- and post-implementation 23.8 % and 33.4 % of patients had day-case surgery respectively. For in-patients median length of stay decreased from 3.2 days (inter-quartile range 1.5–6.1) pre-implementation to 2.5 days (inter-quartile range 1.4–5.4) post-implementation. There were also significant improvements in patient experience, hypo- and hyper-glycaemic events, wound complications and diabetes related complications. ConclusionsThe IP3D intervention has the potential to increase efficiency and reduce waiting lists for elective surgery on a nationwide basis.