Improving the perioperative pathway of patients with diabetes undergoing surgery – a quality improvement project

Abstract

Background: More than 323 000 operations take place in the UK each year in diabetic patients, accounting for 15% of all operative procedures.1 This group continues to have a longer length of stay and higher rates of adverse postoperative outcome.2 As per the 2019 National Diabetes Inpatient Audit (NaDIA), our institution currently operates below the benchmark (staff knowledge and patients’ ability to take control of their diabetes).3 Our length of stay for elective diabetes patients was 0.36 days above the national average.4 Methods: Data were collected prospectively in diabetic patients undergoing elective surgery between 1 and 30 September 2021. Pregnant, paediatric, and non-elective patients were excluded. Patient characteristics and information relevant to perioperative management was collected and analysed against The Centre for Perioperative Care (CPOC) recommendations.4 Results: Our data are shown in Table 1.Table 1Data collected perioperatively in diabetic patients.Characteristics of study subjects. Values are given as mean or n (%). DM, type of diabetes mellitus; CBG, capillary blood glucose.n27Age (yr)69 (49–89)BMI30.4 (18–38.8)ASA 10 214 (51.8%) 312 (44.4%) 41 (0.037%)DM 11 (0.037%) 226 (96.2%)Preop HbA1C <69 mmol L–122 (81.5 %) >69 mmol L–15 (18.5%)Fasting >10 h15 (55.5%)Not first on list20 (74%)WHO Checklist completed27 (100%)Anaesthetic technique GA15 (55.5%) Other12 (44.4%)CBG not measured Intraoperatively12 (44.4%) Postoperatively4 (14.8%)Duration in recovery <1 h20 (74%) >24 h1 (0.037%)Postoperative diabetes management plan As per protocol21 (77.7%) No plan identifiable6 (22.2%)Discharged Day care18 (16.6%) Ward8 (29.6%) HDU1 (0.037%) Open table in a new tab Conclusions: Compliance with CPOC guidelines was variable with some evidence of good practice and some requiring further improvement and education. To improve delivery of care in this group of patients, perioperative interventions were recommended including introduction of individualised perioperative care plans for diabetic patients, flash cards designed for glycaemic management, and development of institutional guidelines for perioperative diabetes management. We emphasise the need for teaching and training of nursing staff and educating patients about their perioperative journey and diabetes management. 1.Rotruck S, Suszan L, Vigersky R, et al. AANA J 2018; 86: 194–2002.Sampson MJ et al. Diabetes Res Clin Pract 2007; 77: 92–83.National Diabetes Inpatient Audit. NHS Digital, 2019. Available from: https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/national-diabetes-inpatient-audit4.Guidelines for perioperative care for people with diabetes mellitus undergoing elective and emergency surgery. Centre for Perioperative Care, 2021. Available from: https://cpoc.org.uk/guidelines-resources-guidelines-resources/guideline-diabetes