Abstract
Basildon and Thurrock University Hospital in the East of England region of the United Kingdom (UK) witnessed rapidly increasing numbers of pregnant women with diabetes, causing overburdened specialist clinics, poorer patient experience and worsening clinical outcomes. This prompted the multidisciplinary team’s remodelling of care pathways, launching the General ownership of Diabetes (GooD) Pregnancy Network in 2014. Contrary to the conventional limitation of care to specialist diabetes antenatal clinics, this novel initiative highlights the contemporary necessity to equip and empower all maternity stakeholders to deliver the basic care of gestational diabetes (GDM). It strategically connects a Midwife Tele-Clinic “hub” to Educating Gestational Diabetics Group Sessions (EGGS) and standard antenatal clinics. Patients were key partners, regularly participating in feedback surveys and promoting public awareness by co-producing local newspaper articles that served up their stories as case studies. Furthermore, the EGGS “faculty” includes a former GDM patient whose video testimony has inspired almost 2000 patients and their families, aiming to foster long term healthy lifestyle changes. The final summative evaluation in November 2019 showed the new culture of wider consciousness has shortened the “diagnosis to first consultation” intervals and eliminated overbooked specialist clinics (none since January 2016), without further worsening of clinical outcomes. It also boosted research recruitment and avoided additional running costs to the tune of GBP 66,384 a year.
Highlights
It is recognised that the prevalence of gestational diabetes mellitus (GDM) varies according to different populations, but the common trend across the world is rising levels of this condition
The primary objective was to reduce the rate of overbooked specialist diabetes antenatal clinics and the rate of delays in first clinic appointments following a diagnosis of GDM
United Kingdom (UK) national guidelines [12] stress the importance of confining the care of diabetes in pregnancy to specialist multidisciplinary antenatal clinics, so the concept of “general ownership” of diabetes in pregnancy is somewhat new
Summary
It is recognised that the prevalence of gestational diabetes mellitus (GDM) varies according to different populations, but the common trend across the world is rising levels of this condition. Such increases are fast becoming a major health problem [1,2,3] and the trend is thought to be partly explained by the advancing of maternal age and increasing rates of obesity [4]. Members of the specialist maternity team had increasingly recognised the adverse effect of this increased workload on care quality and in August 2013, we received our first ever written complaint relating to clinic waiting time. The root cause analysis investigation reports highlighted a recurring theme of suboptimal clinical decisions in overburdened specialist clinics
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