The Assessment and Peri-Operative Management of Diabetes Mellitus in Urological Day Case Surgery—Outcomes of the North West of England Regional Audit

Abstract

Objective: To determine whether patients with diabetes undergoing day surgery in urology units in the North West of England were managed in accordance with published national guidelines. Patients and methods: Data on day cases were collected from 14 NHS Trusts in the region. Proformas including details of pre-operative assessment, peri-operative care and discharge were completed by independent data collectors in individual units. These were audited against the British Association of Day Surgery guidelines for management of patients with diabetes as day cases. Results: 7 patients with type 1 diabetes and 77 with type 2 underwent day case procedures. At pre-operative assessment, 71% patients had a documented glycosylated haemoglobin (HbA1C), 32% had stable serum glucose and 62% had no history of hypoglycaemic attacks. Peri-operatively, 69% had a blood glucose <10mmol/l, 17% had a blood glucose >10mmol/l and in 14% it was not documented. A Glucose-potassium-insulin infusion was commenced in 91% of patients on insulin. On discharge, less than 25% patients were given written advice. Conclusion: Whilst compliance with published guidelines is generally good throughout the region, there is significant room for improvement particularly with respect to documentation and discharge planning. Implementation of dedicated protocols can bring about consistent improvement in practice.